The failure rate, related factors, and neonate complications of vaginal delivery after cesarean section

Azadeh Asgarian, Nayereh Rahmati, Farzaneh Nasiri3, Abolfazl Mohammadbeigi


Background: The rate of Cesarean Section (CS) is high in Iran. A successful Vaginal Birth After Cesarean (VBAC) section can protect mothers against the risk of having multiple CS. This study aimed to evaluate the success rate of VBAC, related factors, and the causes of failure.

Materials and Methods: This cross-sectional study was conducted on 150 pregnant women who were candidates for VBAC and admitted at maternity hospitals in Qom from 2016 to 2018. The required data were collected from the patients' records and entered into the checklist. Then, the success rate of VBAC was estimated, and related factors together with the causes of failure were determined by t-test, Chi-square, and independent-samples t-tests in SPSS v. 18 software.

Results: The mean (SD) maternal age was 32 (5.20) years and ranged from 21 to 45 years old. The success rate of VBAC was estimated to be 85.33%, and 14.67% of the patients had to repeat a CS after failure in vaginal delivery. The mean time between previous CS and present delivery was statistically significant between successful and failure groups (t125 = 2.32, p = 0.002). The results also revealed that the most important causes of VBAC failure were prolonged labor [odds ratio (OR) = 4.70)], full arrest (OR = 2.70), and decline fetal heart (OR = 5.31).

Conclusions: The success rate of VBAC in our study was high. However, VBAC was more successful when the interval between inter-deliveries was long, and lower complications were reported when the interval was 2–4 years.


Cesarean, cesarean section, trial of labor, vaginal birth after cesarean

Full Text:



Darvish S, Etemad K, Mosaheb A, Yazdanpanah G. Comparing maternal and neonatal side effects of natural vaginal delivery under neuro-axial analgesia with usual vaginal delivery and cesarean section: A primary single center study. J Obstet Gynecol Cancer Res 2017: In Press:e11411. doi: 10.5812/jogcr.11411.

Rafiei M, Naz MS, Akbari M, Kiani F, Sayehmiri F, Sayehmiri K, et al. Prevalence, causes, and complications of cesarean delivery in Iran: A systematic review and metaanalysis. Int J Reprod Biomed (Yazd) 2018;16:221-34.

Bangal VB, Giri PA, Shinde KK, Gavhane SP. Vaginal birth after cesarean section. N Am J Med Sci 2013;5:140-4.

Arnold KC, Flint CJ. Vaginal Birth after Previous Cesarean Delivery. In Obstetrics Essentials. Cham: Springer; 2017; 115-21.

Guise JM, Denman MA, Emeis C, Marshall N, Walker M, Fu R, et al. Vaginal birth after cesarean: New insights on maternal and neonatal outcomes. Obstet Gynecol 2010;115:1267-78.

Ananth CV, Friedman AM, Keyes KM, Lavery JA, Hamilton A, Wright JD. Primary and repeat cesarean deliveries: A population-based study in the United States, 1979-2010. Epidemiology 2017;28:567-74.

Kiwan R, Al Qahtani N. Outcome of vaginal birth after cesarean section: A retrospective comparative analysis of spontaneous versus induced labor in women with one previous cesarean section. Ann Afr Med 2018;17:145-50.

Mone F, Harrity C, Toner B, Mcnally A, Adams B, Currie A. Predicting why women have elective repeat cesarean deliveries and predictors of successful vaginal birth after cesarean. Int J Gynecol Obstet 2014;126:67-9.

Mizrachi Y, Barber E, Kovo M, Bar J, Lurie S. Prediction of vaginal birth after one ceasarean delivery for non-progressive labor. Arch Gynecol Obstet 2018;297:85-91.

Cunningham F, Bangdiwala S, Brown S, Dean T, Frederiksen M, Hogue CR, et al. National institutes of health consensus development conference statement: Vaginal birth after cesarean section new insights March 8–10, 2010. Obstet Anesth Dig 2011;31:140-2. 11.Gibbons L, Belizán JM, Lauer JA, Betrán AP, Merialdi M, Althabe F. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: Overuse as a barrier to universal coverage. World Health Rep 2010;30:1-31.

Betrán AP, Torloni MR, Zhang JJ, Gülmezoglu A, Section WWGoC, Aleem H, et al. WHO statement on caesarean section rates. BJOG 2016;123:667-70.

Lundgren I, Begley C, Gross MM, Bondas T. 'Groping through the fog': A metasynthesis of women's experiences on VBAC (Vaginal birth after Caesarean section). BMC Pregnancy Childbirth 2012;12:85.

Sakiyeva KZ, Abdelazim IA, Farghali M, Zhumagulova SS, Dossimbetova MB, Sarsenbaev MS, et al. Outcome of the vaginal birth after cesarean section during the second birth order in West Kazakhstan. J Family Med Prim Care 2018;7:1542-7.

Oboro V, Adewunmi A, Ande A, Olagbuji B, Ezeanochie M, Oyeniran A. Morbidity associated with failed vaginal birth after cesarean section. Acta Obstet Gynecol Scand 2010;89:1229-32.

Crowther CA, Dodd JM, Hiller JE, Haslam RR, Robinson JS, Group BACS. Planned vaginal birth or elective repeat caesarean: Patient preference restricted cohort with nested randomised trial. PLoS Med 2012;9:e1001192.

Wen J, Song X, Ding H, Shen X, Shen R, Hu Lq, et al. Prediction of vaginal birth after cesarean delivery in Chinese parturients. Sci Rep 2018;8:3084.

Haumonte JB, Raylet M, Christophe M, Mauviel F, Bertrand A, Desbriere R, et al. French validation and adaptation of the Grobman nomogram for prediction of vaginal birth after cesarean delivery. J Gynecol Obstet Hum Reprod 2018;47:127-31.

Naji O, Wynants L, Smith A, Abdallah Y, Stalder C, Sayasneh A, et al. Predicting successful vaginal birth after Cesarean section using a model based on Cesarean scar features examined by transvaginal sonography. Ultrasound Obstet Gynecol 2013;41:672-8. 20.Rooeintan F, Borzabad PA, Yazdanpanah A. The impact of healthcare reform plan on the rate of vaginal delivery and cesarean section in Shiraz (Iran) in 2015. Electron Physician 2016;8:3076-80.

Qu Z, Yang M, Du M, Ma C, Tao Y, Chen Z, et al. Outcome of vaginal birth after cesarean section in women with advanced maternal age. Zhonghua Fu Chan Ke Za Zhi 2017;52:521-5.

Xing YP, Qi XY, Wang XZ, Yang FZ. Development of a modified score system as prediction model for successful vaginal birth after cesarean delivery. Clin Transl Sci 2019;12:53-7.

Mirteymouri M, Ayati S, Pourali L, Mahmoodinia M, Mahmoodinia M. Evaluation of maternal-neonatal outcomes in vaginal birth after cesarean delivery referred to maternity of academic hospitals. J Family Reprod Health 2016;10:206-10.

Minsart AF, Liu H, Moffett S, Chen C, Ji N. Vaginal birth after caesarean delivery in Chinese women and Western immigrants in Shanghai. J Obstet Gynaecol 2017;37:446-9. 25.Melamed N, Segev M, Hadar E, Peled Y, Wiznitzer A, Yogev Y. Outcome of trial of labor after cesarean section in women with past failed operative vaginal delivery. Am J Obstet Gynecol 2013;209:49.e1-7.

Boyle A, Reddy UM, Landy HJ, Huang CC, Driggers RW, Laughon SK. Primary cesarean delivery in the United States. Obstet Gynecol 2013;122:33.

Knight H, Gurol-Urganci I, Meulen J, Mahmood T, Richmond D, Dougall A, et al. Vaginal birth after caesarean section: A cohort study investigating factors associated with its uptake and success. BJOG 2014;121:183-92.

Elkousy MA, Sammel M, Stevens E, Peipert JF, Macones G. The effect of birth weight on vaginal birth after cesarean delivery success rates. Am J Obstet Gynecol 2003;188:824-30.

Senturk MB, Cakmak Y, Atac H, Budak MS. Factors associated with successful vaginal birth after cesarean section and outcomes in rural area of Anatolia. Int J Womens Health 2015;7:693-7.

Frass K, Al Harazi A. Outcome of vaginal birth after caesarean section in women with one previous section and spontaneous onset of labour. East Mediterr Health J 2011;17:646-50.

Tsai HT, Wu CH. Vaginal birth after cesarean section—The world trend and local experience in Taiwan. Taiwan J Obstet Gynecol 2017;56:41-5.

Damle LF, Wilson K, Huang CC, Landy HJ, Gomez-Lobo V. Do they stand a chance? Vaginal birth after cesarean section in adolescents compared to adult women. J Pediatr Adolesc Gynecol 2015;28:219-23.

Motomura K, Ganchimeg T, Nagata C, Ota E, Vogel JP, Betran AP, et al. Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO multicountry survey maternal and newborn health. Sci Rep 2017;7:44093.


  • There are currently no refbacks.