Rahman Maria, Qayyum Sidra, Khan Sara, Shoukat Anum, Shamim Amina, Javed Hamza
Obstetrics and Gynaecology, Ayub Teaching Hospital, Abbottabad, PAK.
Cardiology, Benazir Bhutto Shaheed Teaching Hospital, Abbottabad, PAK.
Cureus. 2025 Aug 8;17(8):e89637. doi: 10.7759/cureus.89637. eCollection 2025 Aug.
The rising rates of cesarean sections (CS) globally have increased the number of women with prior cesarean deliveries who may be candidates for vaginal birth after cesarean (VBAC). This study explores the factors influencing the success of VBAC in women with a previous CS and fetomaternal complications associated with VBAC failure.
This cross-sectional study was conducted at the obstetrics unit of Ayub Teaching Hospital, Abbottabad, Pakistan, enrolling 102 eligible women who had previously undergone a CS and were offered the option of attempting a vaginal delivery. Demographic, clinical, and obstetric data were collected on a predesigned proforma. The success of VBAC was defined as a vaginal delivery without the need for an emergency cesarean section. Statistical analysis was done using IBM SPSS Statistics software, version 27.0 (IBM Corp., Armonk, NY).
Participants had a mean age of 30.36 ± 2.07 years and a mean body mass index (BMI) of 25.71 ± 0.90 kg/m². The overall VBAC success rate was 79.4% (n=81), with a failure rate of 20.6% (n=21). Maternal complications, including infection and the need for blood transfusion, were significantly higher in the VBAC failure group. Fetal outcomes also showed that VBAC failures were more likely to result in an Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score <7 at 10 minutes (P=0.006). Similarly, maternal complications were significantly higher in VBAC failures (5/21, 23.8%) than successes (3/81, 3.7%; =0.009). On regression analysis, VBAC failure was found to be an independent predictor of both fetal complications (with an odds ratio of 14.610 (95% CI: 1.290-165.421, p = 0.030)) and maternal complications (with an odds ratio of 8.767 (95% CI: 1.762-44.535, p = 0.009)).
VBAC is a safe and effective option for women with a prior CS, with a high success rate; however, VBAC failure was found to be an independent predictor of both fetal and maternal complications. Our findings suggest the importance of a personalized approach to VBAC assessment and counselling to optimize outcomes for women undergoing trial of labor after cesarean (TOLAC).
全球剖宫产率的上升使得有剖宫产史且可能适合剖宫产术后阴道分娩（VBAC）的女性数量增加。本研究探讨了影响有剖宫产史女性VBAC成功的因素以及与VBAC失败相关的母胎并发症。
本横断面研究在巴基斯坦阿伯塔巴德阿尤布教学医院产科进行，纳入102名有剖宫产史且被提供尝试阴道分娩选择的符合条件女性。通过预先设计的表格收集人口统计学、临床和产科数据。VBAC成功定义为无需急诊剖宫产的阴道分娩。使用IBM SPSS Statistics软件27.0版（IBM公司，纽约州阿蒙克）进行统计分析。
参与者的平均年龄为30.36±2.07岁，平均体重指数（BMI）为25.71±0.90kg/m²。VBAC总体成功率为79.4%（n = 81），失败率为20.6%（n = 21）。VBAC失败组的产妇并发症，包括感染和输血需求，显著更高。胎儿结局还显示，VBAC失败更有可能导致10分钟时的阿氏评分（Appearance, Pulse, Grimace, Activity, and Respiration，APGAR）<7（P = 0.006）。同样，VBAC失败组的产妇并发症（5/21，23.8%）显著高于成功组（3/81，3.7%；P = 0.009）。回归分析发现，VBAC失败是胎儿并发症（优势比为14.610（95%可信区间：1.290 - 165.421，p = 0.030））和产妇并发症（优势比为8.767（95%可信区间：1.762 - 44.535，p = 0.009））的独立预测因素。
VBAC对于有剖宫产史的女性是一种安全有效的选择，成功率较高；然而，VBAC失败是胎儿和产妇并发症的独立预测因素。我们的研究结果表明，采用个性化方法进行VBAC评估和咨询对于优化剖宫产术后试产（TOLAC）女性的结局具有重要意义。
