Outcome of vaginal birth after one caesarean section in enugu state university teaching hospital, parklane enugu, southeast Nigeria

Background: The rate of Caesarean section (CS) has been on the increase in the recent years. Previous caesarean section is a major indication for a repeat caesarean section. The consequences associated with repeat caesarean sections have brought about the need to adopt vaginal birth after caesarean section (VBAC) as the preferred mode of delivery in one previous scarred uterus. Aims and Objectives: To determine the pregnancy outcome and complications of vaginal birth after caesarean section at the Enugu State University Teaching Hospital Parklane Enugu. Materials and Methods: This was a retrospective study of women with one previous caesarean section who presented at the labour ward of the Enugu state University Teaching Hospital Parklane Enugu between January 1, 2019, and December 31, 2023. Data was obtained from the case notes, labour ward registers, and theatre registers, encoded into a spreadsheet, and analysed using SPSS 25.0. The results were presented as frequency and percentages. Results: During the study period, there were 7852 deliveries and 100 planned VBAC. Forty-eight (48%) pregnant women had successful VBAC while 52% had a repeat emergency CS. Successful VBAC in primipara was 15(31.3%) compared to 33(68.7%) in multipara. Repeat CS rate was 23(44.2%) in primipara compared to 29(55.8%) in multipara. A previous vaginal delivery especially a prior vaginal delivery before CS was associated with a higher proportion of successful VBAC 27(56.3%) compared to successful VBAC rate of 14(29.2%) in women who had a vaginal delivery after a previous CS but lowest 7(14.5%) in those women with no previous vaginal delivery. The commonest indication for repeat emergency CS was poor progress in labour due to cephalopelvic disproportion 30(58%), followed by suspected foetal distress 16(32%). The highest 35(72.9%) successful VBAC was seen in babies that weigh between 2.5 to 3.5 kg. Conclusion: Trial of labour after a CS can result in an excellent outcome in a well-selected patient. The success rate of 48% in our study is encouraging. However, sufficient intrapartum feto-maternal monitoring is recommended to reduce foetal and maternal complications.