Pregnancy Outcome Among Women With One Previous Cesarean Delivery Attempting Vaginal Birth at Garissa County Referral Hospital Between April 2019-may 2022 (a Descriptive Cross-sectional Study)

Abstract

Background: Multiple studies have shown Vaginal birth after cesarean (VBAC) has a success rate of 50-70% with minimal maternal and neonatal morbidity and mortality. It’s important to note that for mothers with one previous cesarean section, vaginal birth should be advised as an option of mode of delivery. Whereas trial of labor after cesarean is supposed to be a planned and supervised birthing process of selected women, there are women who are adamant on vaginal birth after cesarean in Northern Kenya and invariably try vaginal birth. This is compounded by a universal lack of objective criteria on who should be subjected to trial of labor after cesarean. This therefore justifies a need for investigating these events for purpose of strengthening policies in the management of women with one previous cesarean section. In urban areas clinician preference is key. “Once a cesarean always a cesarean’’ Craigin dictum. Objective: To determine pregnancy outcomes among women with one previous cesarean delivery attempting vaginal birth in Garissa County Referral Hospital in April 2019-May 2022. Methodology: The study adopted a retrospective cross-sectional study including a total of 188 women with one previous cesarean section attempting vaginal birth in Garissa County referral hospital. Were age between 26-30years, with mean age 26 ±5.23. majority were para 2-4 (46%) .The data was analyzed using SPSS version 26. Women with one previous cesarean delivery attempting vaginal birth with complete files were analyzed. The sociodemographic and reproductive characteristics was used to describe the population and presented as frequencies with percentages for categorical data and means with standard deviation for continuous variables. The Maternal and fetal outcomes were then summarized using frequencies with percentages for categorical data and means with standard deviation for continuous variables. Association between the reproductive characteristics and pregnancy outcome was determined using Chi- square/ Fishers exact test of association. Logistic regression was also carried out to report the crude and adjusted odds ratios with their corresponding 95% confidence intervals. x i Results: Between April 2019-May 2022, data from 188 women with one previous cesarean delivery at >37weeks and above attempting vaginal birth were collected. In the study 57% 108 (n-188) were not recommended to attempt vaginal birth by the clinician, but were defiant. The majority of the women were aged between 26-30 years (mean age = 26 ±5.23). Most of the women were illiterate (68%), 90% of the participants were married, 46% were Para 2-4, 49% had previous VBAC, 69% had <4 antenatal contacts and 55% had an inter-pregnancy interval <24 months. Of the 188 women, 34% had a successful vaginal delivery, while 66% had a failed attempt and underwent repeat cesarean delivery. Uterine rupture occurred in 6% of women, with 3% experiencing complete uterine rupture and 3% having impending uterine rupture. Postpartum hemorrhage and blood transfusion were observed in 20% and 19% of women, respectively. Maternal mortality was recorded in 6% of women. The majority of infants had a birth weight between 2500-3500g (73%). Apgar scores having a score of 7 or higher at 5th minute was 74%. Proportion of infants (10%) were stillborn, respiratory distress syndrome was observed in 27% of infants and were admitted to the neonatal intensive care unit. Women with 1-2 previous VBACs had over 2 times the odds of TOLAC success (AOR 2.97 (1.31-6.73; p = 0.009. Women with 3 or more previous VBACs had over 13 times the odds of TOLAC success (AOR 13.38 (3.59-49.88; p < 0.001).