Success rate of trial of labor after previous cesarean section (tolac), maternal and fetal outcomes, and determinant factors at jimma university medical center: prospective longitudinal study

Abstract

Background: Vaginal delivery after previous one cesarean section for a non-recurring indication has been described by several authors as safe. Encouraging vaginal birth after CS has been considered a key method of reducing the cesarean rate. Although attempts at a Trial of Labor after a Cesarean Birth (TOLAC) have become accepted practice and having a success rate of 60–80%, the rate of successful TOLAC has decreased during the past decades. Concerns about immediate maternal and neonatal complications associated with uterine rupture have contributed to a decrease in vaginal birth after CS rates. Therefore assessing rate of success and factors associated with successful VBAC is very important to for counseling mothers while offering TOLAC as an option. Objective: To determine the success rate of TOLAC, maternal and fetal outcomes, and determinant factors of success of trial of labor after previous cesarean delivery (TOLAC) at Jimma University Medical Center, December 1st, 2017-July 31st, 2018. Jimma, Ethiopia. Methods: The study was a prospective longitudinal study of women with one previous scar who were admitted to maternity and labor ward, JUMC, from 1st of December, 2017 to 31st of July, 2018. Trained midwives and principal investigator collected the data through face-to-face interview and record review by using pre-tested structured questionnaire and checklist respectively. Epidata Version 3.1 was used to enter data and SPSS version 24.0 was used for analysis. Logistic regression analysis was conducted to identify factors associated with success of TOLAC. Result: The success rate of TOLAC was 133 (63.6%) where most (112, [84.2%]) delivered by vaginal route, of which 16 (12.0%) by forceps vaginal delivery and 5 (3.8%) by vacuum vaginal delivery (VVD). For those who delivered by C/S, the leading indications were prolonged latent phase of labor (28, [36.8%]), arrest of labor (20, [26.3%]), NRFHR (14, [18.4%]) and CPD (11, [14.5%]). Indication for previous C/S CPD or malpresentation compared to NRFHR, (AOR: 0.358, 95% CI: 0.141,0.907) & (AOR: 0.335, 95% CI: 0.120, 0.938) respectively, interval from previous pregnancy (less than 2 years compared to 2 years and above (AOR: 0.450, 95% CI: 0.222, 0.910), phase of labor (active compared to latent (AOR: 2.415, 95% CI: 1.236, 4.719) and second stage compared to latent (AOR: 4.551, 95% CI: 1.030, 22.949) and parity (Para one compared to para two and above mother (AOR: 0.395, 95% CI: 0.200, 0.782) were factors significantly associated with success of TOLAC. Neonatal intensive care admission was significantly higher in the successful TOLAC group (6/8). Perinatal mortality rate (PNMR) was 14.4/1000. The leading intrapartum complication was NRFHRP (17/19). There was one case of uterine rupture, making the rate of 0.5%, and there was a case of iatrogenic bladder injury among failed TOLAC participants.