Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Department of Midwifery, College of Medicine and Health Sciences, Haramaya University, Haramaya, Ethiopia.
Sci Rep. 2023 May 31;13(1):8871. doi: 10.1038/s41598-023-36027-1.
A Trial of labor after cesarean section is an attempt to deliver vaginally by a woman who had a previous cesarean delivery and when achieved by a vaginal delivery it is called successful vaginal birth after cesarean section. Vaginal birth after a caesarian section is a preferred method to decrease complications associated with repeated caesarian section delivery for both mother and fetus. It has a higher success rate when the right women are selected for a trial of labor. This study aimed to assess factors associated with successful vaginal birth after one lower uterine transverse cesarean section and to validate the Flamm and Geiger score at the public hospitals of Bahir Dar City, Northwest, Ethiopia, 2021. A health facility-based retrospective cross-sectional study was conducted from March 1 to 15/2021. A medical record review of 408 women charts with a trial of labor after one lower uterine transverse cesarean section from January 1/2020 to December 31/2020 was done and 345 women charts with complete maternal and fetal information were included in the study with a response rate of 84.6%. The data were collected using a structured checklist, entered into Epi data 3.1, and analyzed using SPSS 25.0 version. Logistic regression analyses were done to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of less than 0.05 considered statistically significant. This study identified that the trial of labor after cesarean section rate was 69.5%, and the success rate of vaginal birth after one lower uterine transverse cesarean section was 35.07%. Of the failed trial of labor, fetal distress (38.9%) and failed progress of labor (32.1%) were the main indications for an emergency cesarean section. The maternal age group of 21-30 years, prior vaginal birth after or before cesarean section, non-recurring indication (fetal distress and malpresentation), ruptured membrane, cervical dilatation ≥ 4 cm, cervical effacement ≥ 50%, and low station (≥ 0) at admission were associated with successful vaginal birth after one lower uterine transverse cesarean section. For the Flamm and Geiger score at a cut point of 5, the sensitivity and specificity were 73.6% and 86.6% respectively. In this study area, the trial of labor after cesarean section rate is encouraging, however, the success rate of vaginal birth after one lower uterine transverse caesarian section was lower. The maternal socio-demographic and obstetric-related factors were significantly associated with successful vaginal birth after one lower transverse caesarian section delivery. This study indicated that when the Flamm and Geiger score increases, the chance of successful vaginal birth after one lower uterine transverse caesarian section also increases. We suggest emphasizing counselling and encouraging the women, as their chance of successful vaginal delivery will be high in the subsequent pregnancy, especially if the indications of primary caesarian section delivery were non-recurring.
剖宫产后试产是指对曾行剖宫产的女性尝试经阴道分娩,若经阴道分娩成功,则称为剖宫产术后阴道分娩。剖宫产后阴道分娩是减少母婴重复剖宫产相关并发症的首选方法。当选择正确的女性进行试产时,其成功率更高。本研究旨在评估与一次子宫下段横行剖宫产术后成功阴道分娩相关的因素,并验证 2021 年在埃塞俄比亚巴赫达尔市公立医院的 Flamm 和 Geiger 评分。这是一项 2021 年 3 月 1 日至 15 日进行的基于医疗机构的回顾性横断面研究。对 2020 年 1 月 1 日至 12 月 31 日期间进行过一次子宫下段横行剖宫产术后试产的 408 名妇女的病历进行了回顾,并纳入了 345 名具有完整母婴信息的妇女,应答率为 84.6%。数据使用结构化检查表收集,输入 EpiData 3.1,并使用 SPSS 25.0 版本进行分析。使用 95%置信区间和 P 值<0.05 的逻辑回归分析分别估计粗比和调整比值。本研究发现,剖宫产术后试产率为 69.5%,一次子宫下段横行剖宫产术后阴道分娩成功率为 35.07%。在试产失败的病例中,胎儿窘迫(38.9%)和产程进展失败(32.1%)是紧急剖宫产的主要指征。产妇年龄在 21-30 岁、既往有剖宫产术后阴道分娩或剖宫产术前阴道分娩、非复发指征(胎儿窘迫和胎位不正)、胎膜早破、宫颈扩张≥4cm、宫颈消退≥50%和低位(≥0)入院与一次子宫下段横行剖宫产术后阴道分娩成功相关。对于 Flamm 和 Geiger 评分的截断值为 5,其灵敏度和特异度分别为 73.6%和 86.6%。在本研究地区,剖宫产术后试产率令人鼓舞,然而,一次子宫下段横行剖宫产术后阴道分娩成功率较低。产妇的社会人口统计学和产科相关因素与一次子宫下段横行剖宫产术后阴道分娩成功显著相关。本研究表明,当 Flamm 和 Geiger 评分增加时,一次子宫下段横行剖宫产术后阴道分娩成功的机会也会增加。我们建议强调咨询和鼓励这些女性,因为她们在下一次妊娠中成功阴道分娩的机会很高,尤其是在初次剖宫产的指征是非复发的情况下。