Introduction: Trial of Labor After Cesarean (TOLAC) is an alternative to iterative cesarean section. This study aimed to identify maternal-fetal factors associated with the outcome of TOLAC in four referral hospitals in Cameroon. Methodology: This was a retrospective case-control study conducted from January 2016 to December 2018 at the Yaoundé Central Hospital, the Yaoundé Teaching Hospital, the Douala Gyneco-Obstetric and Pediatric Hospital, and the Douala General Hospital. Cases (VBAC success) and controls (TOLAC failure) were matched according to maternal age and delivery site. Multivariate analysis identified factors independently associated with a favourable outcome. Results: Out of 468 women with unicatricial uterine who attempted vaginal delivery, 156 were successful and 312 were unsuccessful. Factors independently associated with a favorable outcome were: a favorable Bishop score (aOR = 42.24; 95% CI: 22.04 - 84.12), dilation ≥ 5 cm at admission (aOR = 7.63; 95% CI: 4.73 - 12.36), an estimated fetal weight between 2500 - 3500 g (aOR = 2.13; 95% CI: 1.44 - 3.17), clear amniotic fluid (aOR = 3.18; 95% CI: 1.73 - 6.16), and the absence of major obstetric comorbidities (aOR = 5.09; 95% CI: 2.1 - 14.73). Conclusion: Both maternal and fetal characteristics influence TOLAC outcomes. These results support the development of appropriate protocols to reduce unnecessary cesarean sections in resource-limited settings like Cameroonian hospitals.
References
[1]
Betrán, A.P., Ye, J., Moller, A., Zhang, J., Gülmezoglu, A.M. and Torloni, M.R. (2016) The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLOS ONE, 11, e0148343. https://doi.org/10.1371/journal.pone.0148343
[2]
Boerma, T., Ronsmans, C., Melesse, D.Y., Barros, A.J.D., Barros, F.C., Juan, L., et al. (2018) Global Epidemiology of Use of and Disparities in Caesarean Sections. The Lancet, 392, 1341-1348. https://doi.org/10.1016/s0140-6736(18)31928-7
[3]
Cavallaro, F.L., Cresswell, J.A., França, G.V., Victora, C.G., Barros, A.J. and Ronsmans, C. (2013) Trends in Caesarean Delivery by Country and Wealth Quintile: Cross-Sectional Surveys in Southern Asia and Sub-Saharan Africa. Bulletin of the World Health Organization, 91, 914-922D. https://doi.org/10.2471/blt.13.117598
[4]
Njim, T., Tanyitiku, B.S. and Mbanga, C. (2020) Prevalence, Indications and Neonatal Complications of Caesarean Deliveries in Cameroon: A Systematic Review and Meta-Analysis. Archives of Public Health, 78, Article No. 51. https://doi.org/10.1186/s13690-020-00430-1
[5]
Halle-Ekane, G., Nkwabong, E., Njim, T., et al. (2022) Maternal and Neonatal Outcomes after Caesarean Delivery in Cameroon: A Multicenter Prospective Study. BMC Pregnancy Childbirth, 22, Article No. 130.
[6]
Landon, M.B., Hauth, J.C., Leveno, K.J., Spong, C.Y., Leindecker, S., Varner, M.W., et al. (2004) Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery. New England Journal of Medicine, 351, 2581-2589. https://doi.org/10.1056/nejmoa040405
[7]
Fitzpatrick, K.E., Kurinczuk, J.J., Alfirevic, Z., Spark, P., Brocklehurst, P. and Knight, M. (2012) Uterine Rupture by Intended Mode of Delivery in the UK: A National Case-Control Study. PLOS Medicine, 9, e1001184. https://doi.org/10.1371/journal.pmed.1001184
[8]
Grobman, W.A., Lai, Y., Landon, M.B., Spong, C.Y., Leveno, K.J., Rouse, D.J., et al. (2007) Development of a Nomogram for Prediction of Vaginal Birth after Cesarean Delivery. Obstetrics & Gynecology, 109, 806-812. https://doi.org/10.1097/01.aog.0000259312.36053.02
[9]
Kemfang, J.D.N., Fouogue, J.T., Nzali, B.S., Djuikwo, F.T., Dipanda, A.N. and Kenfack, B. (2021) Childbirth Patterns after Previous Caesarean Birth in Sub-Saharan Africa: A Retrospective Analytical Study in Two Referral Hospitals in a Semi-Urban Setting in Cameroon. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 10, 4066-4075. https://doi.org/10.18203/2320-1770.ijrcog20214312
[10]
Momat, F.K., Zalagile, P.A., Mukalenge, F.C., Luboya, O.N., Kalala, C.T., Mashinda, D., et al. (2017) Scarred Uterine Deliveries in the Democratic Republic of Congo: Uterine Challenge and Determinants of Outcome. Pan African Medical Journal, 27, Article 71.
[11]
Birara, M. and Gebrehiwot, Y. (2013) Factors Associated with Success of Vaginal Birth after One Caesarean Section (VBAC) at Three Teaching Hospitals in Addis Ababa, Ethiopia: A Case Control Study. BMC Pregnancy and Childbirth, 13, Article No. 31. https://doi.org/10.1186/1471-2393-13-31
[12]
Trojano, G., Damiani, G.R., Olivieri, C., Villa, M., Malvasi, A., Alfonso, R., et al. (2019) Antenatal Predictors of Success. Acta Biomaterialia, 90, 300-309.
[13]
Tahseen, S. and Griffiths, M. (2010) Vaginal Birth after Two Caesarean Sections (VBAC‐2)—A Systematic Review with Meta‐Analysis of Success Rate and Adverse Outcomes of VBAC‐2 versus VBAC‐1 and Repeat (Third) Caesarean Sections. BJOG: An International Journal of Obstetrics & Gynaecology, 117, 5-19. https://doi.org/10.1111/j.1471-0528.2009.02351.x
[14]
İzbudak, G., Tozkır, E., Cogendez, E., Uzun, F. and Eser, S.K. (2021) Comparison of Maternal-Neonatal Results of Vaginal Birth after Cesarean and Elective Repeat Cesarean Delivery. Ginekologia Polska, 92, 306-311. https://doi.org/10.5603/gp.a2020.0132
[15]
FIGO Committee (2015) Guidelines for Appropriate Care in VBAC. International Journal of Gynecology & Obstetrics, 128, 131-136.
[16]
CNGOF (2012) Recommendations for Clinical Practice-Childbirth after Cesarean Section. European Journal of Obstetrics and Gynecology and Reproductive Biology, 41, 501-520.
[17]
Guise, J.M., McDonagh, M.S., Osterweil, P., Nygren, P., Chan, B.K., Helfand, M., et al. (2010) Vaginal Birth after Cesarean: New Insights. Agency for Healthcare Research and Quality.
[18]
Rosen, I.D. and Cahill, A.G. (2013) Contemporary Management of the Trial of Labor after Cesarean Delivery. Clinical Obstetrics and Gynecology, 56, 403-412.
[19]
Tegegne, G.A., Rade, B.K., Yismaw, A.E., Taye, W. and Mengistie, B.A. (2024) Predictors of Successful Trial of Labor after Cesarean Section (TOLAC) in Women with One Prior Transverse Cesarean Section at Tertiary Hospitals in Northwest Ethiopia: A Multicenter Study. BMC Pregnancy and Childbirth, 24, Article No. 240. https://doi.org/10.1186/s12884-024-06432-z
[20]
Gebremedhin, A.T., Tsegaye, A.T., Tadesse, A.W., et al. (2023) Trend, Prevalence and Predictors of Successful Vaginal Birth after Caesarean Section in Ethiopia: A Systematic Review and Meta-Analysis. International Health, 16, 371-379. https://doi.org/10.1093/inthealth/ihad048
