Abstract:

Introduction: Vaginal delivery following caesarean section is one of the option among pregnant women with one previous caesarean section. The primary objective was to determine the incidence, predictors and outcome of viginal delivery among pregnant women with one previous caesarean section delivering at Bugando Medical Centre.

Methods: In this prospective cohort study, 190 pregnant women with one previous scar were recruited in the study over a period of 8 months. Factors contributing to successful vaginal delivery such as maternal age and body mass index, prior vaginal delivery, parity, cervical dilatation on admission and estimated fetal weight were studied. Maternal and perinatal outcome following delivery was assessed.

Results: Success rate of vaginal delivery was 44.21%. Normal maternal body mass index (p=0.004), advanced cervical dilatation admission (p=0.01), estimated foetal weight of ≤3kg (p=0.01) and prior vaginal delivery and high parity (p<0.01) were statistically significant predictors of successful vaginal delivery. There were 4(2.11%) postpartum hemorrhage due to uterine atony and 1(0.53%) hysterectomy following uterine rupture. We had no maternal mortality. We had nine (4.74%) babies admitted to neonatal intensive care unit due to low apgar score and difficulty in breathing. There was one (0.53%) perinatal death due to severe birth asphyxia related to uterine rupture. Two (2.17%) cases were delivery by vacuum with good outcome due to prolonged second stage of labour.

Conclusion: Vaginal delivery among pregnant women with one previous caesarean delivery can safety be undertaken at our referral Centre by careful selection considering predictive determinants