Ferede Yeshiwas Ayale, Habitu Yohannes Ayanaw, Tassew Worku Chekol, Bitew Desalegn Anmut
Department of Reproductive health, Teda health Science College, Gondar, Ethiopia.
Department of Reproductive health, Institute of Public Health, College of Medicine and health Sciences, University of Gondar, Gondar, Ethiopia.
Contracept Reprod Med. 2025 Apr 7;10(1):29. doi: 10.1186/s40834-025-00360-9.
Caesarean section (CS) is an essential, life-saving surgical intervention used to address obstetric complications. Nonetheless, its excessive use has raised global concerns. In low- and middle-income countries (LMICs) like Ethiopia, the challenges of repeat CS and the limited success of VBAC are particularly problematic. Despite this, there is a significant gap in knowledge regarding vaginal births following a cesarean delivery in Ethiopia, especially in the specific study area.
To determine the prevalence and associated factors of successful vaginal birth after one caesarean section in the University of Gondar Comprehensive Specialized Hospital.
Institutional based cross-sectional study was conducted among 409 women who were randomly selected and had one previous caesarean section delivery and underwent a trial of labor. Data were analyzed and computed using Stata version 14 Software. Multivariable logistic regression analysis was performed to identify the factors associated with successful vaginal birth after caesarean section. A crude and adjusted odds ratio with a 95% confidence interval was used to interpret the results. A P value of < 0.05 indicated statistically significant results.
Of 385 completed charts reviewed, the success rate of vaginal birth after caesarean section was 38.2%,( 95%CI;33.3-43.1%).The factors associated with successful vaginal birth after cesarean section were: prior history of spontaneous vaginal delivery at any point time (AOR = 1.84,95% CI;1.02-3.33), prior history of successful vaginal birth after previous cesarean section (AOR = 2.12, 95%CI;0.97-4.64), no history of stillbirth (AOR = 1.78, 95% CI;1.03-3.07), cervical dilation on admission ≥ 3 cm (AOR = 2.22, 95% CI; 1.14-4.35), station on admission ≥ 0(AOR = 1.94, 95% CI; 1.12-3.37), and Antenatal care follow-up (AOR = 2.48,95%CI;1.26-4.88).
Our study demonstrated a low prevalence of successful VBAC, highlighting that factors such as a prior history of VBAC, spontaneous vaginal delivery at any time, cervical dilatation at admission, history of stillbirth, ANC follow-up, and fetal station at admission are significantly associated with positive outcomes. This evidence clearly indicates that targeted, evidence-based interventions are urgently needed to improve VBAC success rates. Therefore; the Federal Ministry of Health (FMOH), policymakers, and relevant stakeholders should collaborate to develop, implement, and continuously review comprehensive policies and guidelines that support these targeted interventions.
剖宫产是用于处理产科并发症的一项重要的挽救生命的外科手术。尽管如此，其过度使用已引起全球关注。在像埃塞俄比亚这样的低收入和中等收入国家，再次剖宫产的挑战以及剖宫产后阴道分娩成功率有限的问题尤为突出。尽管如此，埃塞俄比亚在剖宫产后阴道分娩方面的知识存在重大差距，尤其是在特定研究区域。
确定贡德尔大学综合专科医院剖宫产后一次成功阴道分娩的患病率及相关因素。
对409名随机选取的、曾有过一次剖宫产且接受引产的妇女进行基于机构的横断面研究。使用Stata 14软件对数据进行分析和计算。进行多变量逻辑回归分析以确定与剖宫产后成功阴道分娩相关的因素。采用95%置信区间的粗比值比和调整后比值比来解释结果。P值<0.05表示具有统计学意义的结果。
在审查的385份完整病历中，剖宫产后阴道分娩的成功率为38.2%（95%置信区间；33.3 - 43.1%）。与剖宫产后成功阴道分娩相关的因素有：既往任何时候有自然阴道分娩史（调整后比值比 = 1.84，95%置信区间；1.02 - 3.33），既往剖宫产后有成功阴道分娩史（调整后比值比 = 2.12，95%置信区间；0.97 - 4.64），无死产史（调整后比值比 = 1.78，95%置信区间；1.03 - 3.07），入院时宫颈扩张≥3cm（调整后比值比 = 2.22，95%置信区间；1.14 - 4.35），入院时胎先露≥0（调整后比值比 = 1.94，95%置信区间；1.12 - 3.37），以及产前检查随访（调整后比值比 = 2.48，95%置信区间；1.26 - 4.88）。
我们的研究表明剖宫产后成功阴道分娩的患病率较低，突出表明既往剖宫产后阴道分娩史、任何时候的自然阴道分娩史、入院时宫颈扩张、死产史、产前检查随访以及入院时胎儿先露等因素与阳性结局显著相关。这一证据清楚地表明迫切需要有针对性的、基于证据的干预措施来提高剖宫产后阴道分娩的成功率。因此，联邦卫生部、政策制定者和相关利益攸关方应合作制定、实施并持续审查支持这些针对性干预措施的全面政策和指南。
