Factors associated with failed vaginal delivery in women with one previous caesarean section at the university teaching hospital, Lusaka, Zambia

Abstract

Trial of labour after one previous caesarean section is safe in appropriately selected women with the addition of adequate intrapartum monitoring and ready access to theatre when emergency caesarean section is indicated. The primary objective of this study was to explore the major obstetric outcomes and factors associated with failed VBAC at UTH- WNH Lusaka Zambia. This was a comparative prospective cross-sectional study spanning from July 2017 to December 2017. A purposeful sample of 356 consenting women with one previous caesarean section who had a failed VBAC and women who had a successful VBAC in a ratio of 1:1 was studied. The average annual delivery was 14,835. Successful VBAC accounted for 70.67% while 29.33% had failed VBAC. The data obtained from questionnaires was analysed using Statistical Package for Social Science (SPSS). There were 104(29.3%) women booked at UTH antenatal clinic as compared to 252 (70.7%) women enrolled in this study who were referred to UTH- WNH as it is a tertiary level referral hospital. Furthermore, although not statistically significant, more women with failed VBAC 39 (22%) had low birth weight babies compared to 25 (14%) of those with successful VBAC (p 0.132) and 20 (11%) had birth weight > 4000g versus successful VBAC 12 (7%) with (p 0.323). There was a great association with failed VBAC regarding maternal age, parity, number of ANC visits, gestational age at delivery, birth weight, Apgar score at one minute and Apgar score at five-minutes. TOLAC remains a moderately safe option for child birth at UTH-WNH Lusaka Zambia. There is a significantly high VBAC success rate among carefully selected women undergoing trial of scar in Zambia although a decreasing trend towards TOLAC and a rising caesarean section rate were determined. Key Words: Trial of Labour after Caesarean Section, Vaginal birth after caesarean section