Feto-maternal outcomes in patients undergoing trial of labor following prior caesarean delivery at a secondary care obstetric facility in Pakistan

Uzma Saleem; Nidda Yaseen; Shahzad Bashir Momina; Aamna Khokhar; Aiman Farogh Anjum

Abstract
Objective: To analyze the feto-maternal outcomes in women undergoing trial of labor after cesarean (TOLAC) at a secondary care obstetric facility with the correlation between demographic and clinical characteristics.
Methodology: This cross-sectional study was carried out at Department of Obstetrics and Gynecology CMH Sargodha from February 2021 to March 2022. A total of 161 women at more than 34 weeks of gestation, between 20 to 40 years of age, with previous cesarean section at least two years ago were included. Demographic, clinical parameters and feto-maternal outcomes were recorded and their correlation was determined by Chi square test.
Results: Out of 161 women, 59% had SVD and 34.8% had to undergo LSCS. Factors associated with unsuccessful TOLAC were, illiteracy (16.8%), no history of previous vaginal delivery (59%), fetal distress (32.1%), MSL (26.8%), failed labor progress (41.1%), scar dehiscence (9.4%) and ruptured uterus (1.2%). Among fetal outcomes, 80.7% had good APGAR score while 19.3% needed NICU admission.
Conclusion: The current study suggests positive correlation between less education, no prior vaginal delivery, induction of labor, fetal distress, meconium-stained liquor, prolonged labor and failed progress of labor, scar disruption, poor neonatal outcomes with unsuccessful TOLAC leading to caesarean delivery.

Key words: Caesarean section, trial of labor after cesarean, TOLAC, vaginal birth after cesarean, VBAC.

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