Publication:

Maternal complications and success rates of vaginal delivery in women with a previous caesarean section: experience from Dhaka Medical College Hospital

Background Caesarean section rates are rising globally, with previous caesarean sections being a leading reason for repeats. Vaginal birth after caesarean section (VBAC) is key to reducing this trend. However, local data on VBAC outcomes in Bangladesh are scarce. This study evaluated the success rate of vaginal delivery and maternal complications among women with previous caesarean sections who underwent a trial of labour at a tertiary hospital in Dhaka, Bangladesh.

Methods This cross-sectional observational study was conducted at the Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, from April to October 2023. One hundred women with one or two previous caesarean sections who were planned for vaginal delivery were enrolled. Descriptive statistics were used for the analysis.

Results The mean age of the participants was 29.8±11.4 years, with 62.0% living in urban areas. Most (82.0%) were at term gestation and fetal distress was the main reason for prior caesarean section (57.0%). VBAC success was 76.0%. Of the 24 failed labour trials, non-progress with impending uterine rupture led to repeat caesarean (19 cases). The maternal complication rate was 17.0%, with postpartum hemorrhage, wound infection and perineal injury rates of 9.0 %, 5.0% and 3.0%, respectively. No cases of uterine rupture were recorded.

Conclusion VBAC is feasible and safe for carefully selected women in tertiary settings in Bangladesh. A 76.0% success rate and low serious complication rate support structured labour trial programs in well-equipped institutions.