MAGNITUDE AND FACTORS ASSOCIATED WITH SUCCESS OF VAGINAL BIRTH AMONG MOTHERS WHO HAD TRIAL OF LABOUR AFTER ONE PREVIOUS CESAREAN DELIVERY IN hIWOT fANA SPECIALIZED UNIVERSITY HOSPITAL, HARAR, EASTERN ETHIOPIA

Abstract

Caesarean section (CS) is becoming the most frequently performed surgical procedure worldwide. Even though, variation exists in the rates of CS across and within countries, it ranges from 10% to 40%. The increase in CS, especially primary CS is further contributed to repeated CS. As such, vaginal birth after cesarean section (VBAC) is emerging as a strategy to reduce repeated CS. VBAC is often associated with shorter maternal hospitalizations, less blood loss and fewer transfusions, fewer infections, and fewer thromboembolic events than cesarean delivery. Although VBAC is becoming common, level of its implementation and success rates is less studied in eastern Ethiopia. Objective: the objective of this study was to assess the magnitude and factors associated with success of vaginal birth among mothers who had trial of labour after one previous CS in Hiwot Fana Specialized University Hospital, 2020 Methods: A facility based cross-sectional study design was used. All records of women who underwent TOLAC from September 2019 to August 2020 in Hiwot Fana Specialized University Hospital were reviewed. Data on socio-demographic conditions, obstetric and reproductive conditions, delivery related information (mode of delivery, delivery outcome and indications for CS) were collected by trained midwives using a standard data abstraction sheet. All collected data were entered and analyzed using SPSS 20. Binary and multiple logistic regression were used to identify factors associated with successful trial of labor (vaginal delivery). All variables with p-value <0.05 in the multiple logistic regression were considered statistically significant. Results: Of a total 224women who underwent TOLAC, 210(93.8%) with complete information were included in this study. The success rate (vaginal delivery) was 61.4%. Among women with failed TOLAC, the most common indication for emergency repeated CS was dystocia (59%). Successful vaginal birth after cesarean was more likely among women with ruptured membrane on admission (AOR=2.490; 95% CI: 1.404-44.18), cervical dilation >4cm on admission (AOR= 3.113;95% CI: 1.585-6.112), prior successful VBAC (AOR=6.807 ; 95% CI: 2.282-20.30) , SEFW between 1500-2499gm (AOR 7.589; 95% CI 3.158-18.234) Conclusion: We found that the success of TOLAC in our study area was 61.4%. Women with prior successful VBAC, cervical dilatation > 4cm on admission, ruptured membrane and SEFW < 2.5 kg will be more likely to have successful VBAC.