Success Rate of Trial of Labor after Cesarean Delivery and Its Determinants at Wolkite University Specialized Teaching Hospital, Retrospective Study (2years)

Abstract

Background Cesarean section (C-section) is a surgical procedure performed when vaginal delivery poses a risk to the mother or child, either as a planned elective procedure or an emergency during labor. With rising global C-section rates, Trial of Labor after Cesarean (TOLAC) has become a key focus in obstetrics, offering women with a prior cesarean the possibility of a vaginal birth in subsequent pregnancies, having a success rate of 60–80%. The success of TOLAC depends on factors like previous vaginal delivery, spontaneous labor, maternal age, and favorable cervix, with careful selection of candidates crucial to ensuring positive outcomes. This research examines the predictors of TOLAC success and aims to contribute to better clinical decisionmaking in managing pregnancies following a previous cesarean delivery. Objective Determine the success rate of TOLAC based on maternal and neonatal outcome and its determinant factors in WUSTH from the time period of November, 2022 to November 2024. Methods The study was a retrospective study on women with one previous scar who were admitted to maternity and labor ward, WKUSTH from the time period of November, 2022 to November 2024. Data was collected from patients’ charts after tracing by medial record number from registry of deliveries. The information was collected using a semi structured questionnaire by document review. Data was entered and analyzed using SPSS version 27 computer software packages. Result A successful Trial of Labor after Cesarean (TOLAC) was achieved in approximately two-thirds of women with one previous cesarean section (CS), resulting in a success rate of 61.2% (120 women). This success rate aligns with findings from other studies, where TOLAC success rates typically range from 60.0% to 80.0%. However, our success rate is slightly lower compared to a study conducted across three teaching hospitals in Ethiopia. Meanwhile, 38.8% (76 women) of the participants required an emergency repeat cesarean section (ERCS), with the majority of these cases attributed to non-reassuring fetal heart rate patterns (NRFHRP) (46.1%), and followed by failure to progress in labor (36.8%) and malpresentation (14.4%). The majority of mothers who attempted TOLAC had a prior vaginal delivery, were between the ages of 25 and 29, and had a previous cesarean section for non-recurring indications. These findings are consistent with global data, which suggest that successful TOLAC candidates typically have a history of vaginal delivery, are relatively younger, and have undergone a cesarean for reasons that are not likely to recur. Among the neonates delivered by mothers who underwent TOLAC, 93.9% (184 neonates) had an APGAR score of 7 or higher, while 6.1% (12 neonates) had an APGAR score of 6 or lower. Of these, 2.5% (5 neonates) experienced early neonatal death, with 3 deaths occurring in the ERCS group and 2 in the successful TOLAC group. Conclusion In conclusion, this study demonstrated a TOLAC success rate of 61.2%, consistent with the success rates reported in the literature, though slightly lower than findings from a multi-center study conducted in Ethiopia. Parity and previous CS indication were found to be significantly associate with success rate of TOLAC. The primary indications for emergency repeat cesarean sections were non-reassuring fetal heart rate patterns and failure to progress in labor. Neonatal outcomes were favorable, with the majority of neonates achieving an APGAR score of 7 or higher, although early neonatal mortality was observed in both the TOLAC and ERCS groups.