Examining the Frequency of Complications of Vaginal Birth After Cesarean Delivery in Postpartum Time: A Retrospective Case-Series
Abstract
This study investigates the complications associated with unplanned vaginal birth after cesarean delivery (VBAC) among women in Sistan-Balochistan province, who often delay hospital visits until labor is imminent due to concerns about clinician acceptance. A retrospective case-series study was conducted at Khash and Baharloo hospitals from September 2021 to October 2022. Data on all VBAC deliveries were collected from hospital records with informed consent. Maternal demographics, delivery profiles, and complications were analyzed using SPSS 22 software. The study investigated the safety and complications associated with vaginal birth after cesarean (VBAC) among 120 women, ultimately analyzing data from 114 participants after excluding those who underwent cesarean delivery due to failed trial of labor after cesarean (TOLAC). Out of 114 women who achieved VBAC, there were no maternal deaths. Complications included 5 (4.3%) uterine ruptures and 2 (1.7%) cases of endometritis. Four neonates had an Apgar score< 7 at five minutes, including one intrauterine fetal death (IUFD). Understanding the complications associated with VBAC is essential for developing localized guidelines tailored to individual patient needs.
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9. Tampakoudis P, Assimakopoulos E, Grimbizis G, Zafrakas M, Tampakoudis G, Mantalenakis S, et al. Cesarean section rates and indications in Greece: data from 24 years in a teaching hospital. Clin Exp Obstet Gynecol 2004;31:289-92.
10. Timofeev J, Reddy UM, Huang CC, Driggers RW, Landy HJ, Laughon SK. Obstetric complications, neonatal morbidity, and indications for cesarean delivery by maternal age. Obstet Gynecol 2013;122:1184-95.
11. Zaigham M, Varallo J, Thangaratinam S, Nicholson W, Visser GHA. Global disparities in caesarean section rates: why indication-based metrics are needed. PLOS Glob Public Health 2024;4:e0002877.
12. Betrán AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health 2021;6:e005671.
13. 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.
14. Fobelets M, Beeckman K, Faron G, Daly D, Begley C, Putman K. Vaginal birth after caesarean versus elective repeat caesarean delivery after one previous caesarean section: a cost-effectiveness analysis in four European countries. BMC Pregnancy Childbirth 2018;18:1-10.
15. Talaulikar VS, Arulkumaran S. Vaginal birth after caesarean section. Obstet Gynaecol Reprod Med 2015;25:195-202.
16. Panda S, Begley C, Daly D. Clinicians’ views of factors influencing decision-making for caesarean section: a systematic review and metasynthesis of qualitative, quantitative and mixed-methods studies. PLoS One 2018;13:e0200941.
17. Lundgren I, Begley C, Gross MM, Bondas T. Groping through the fog: a metasynthesis of women’s experiences on VBAC. BMC Pregnancy Childbirth 2012;12:1-11.
18. Chen HY, Blackwell SC, Chauhan SP. Association between Apgar score at 5 minutes and adverse outcomes among low-risk pregnancies. J Matern Fetal Neonatal Med 2022;35:1344-51.
19. Laughon SK, Zhang J, Troendle J, Sun L, Reddy UM. Using a simplified Bishop score to predict vaginal delivery. Obstet Gynecol 2011;117:805-11.
20. Macones GA, Peipert J, Nelson DB, Odibo A, Stevens EJ, Stamilio DM, et al. Maternal complications with vaginal birth after cesarean delivery: a multicenter study. Am J Obstet Gynecol 2005;193:1656-62.
21. Zhang J, Landy HJ, Branch DW, Burkman R, Haberman S, Gregory KD, et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol 2010;116:1281-7.
22. Guise JM, Eden K, Emeis C, Denman MA, Marshall N, Fu RR, et al. Vaginal birth after cesarean: new insights. Evid Rep Technol Assess 2010;191:1-397.
23. Cahill AG, Stamilio DM, Odibo AO, Peipert JF, Ratcliffe SJ, Stevens EJ, et al. Is vaginal birth after cesarean or elective repeat cesarean safer in women with a prior vaginal delivery? Am J Obstet Gynecol 2006;195:1143-7.
24. Young CB, Liu S, Muraca GM, Sabr Y, Pressey T, Liston RM, et al. Mode of delivery after a previous cesarean birth and associated maternal and neonatal morbidity. CMAJ 2018;190:E556-64.
25. Wingert A, Hartling L, Sebastianski M, Johnson C, Featherstone R, Vandermeer B, et al. Clinical interventions that influence vaginal birth after cesarean delivery rates: systematic review and meta-analysis. BMC Pregnancy Childbirth 2019;19:1-19.
26. Li WH, Yang MJ, Wang PH, Juang CM, Chang YW, Wang HI, et al. Vaginal birth after cesarean section: 10 years of experience in a tertiary medical center in Taiwan. Taiwan J Obstet Gynecol 2016;55:394-8.
27. Tilden EL, Cheyney M, Guise JM, Emeis C, Lapidus J, Biel FM, et al. Vaginal birth after cesarean: neonatal outcomes and United States birth setting. Am J Obstet Gynecol 2017;216:403.e1-8.
2. Gregory KD, Jackson S, Korst L, Fridman M. Cesarean versus vaginal delivery: whose risks? Whose benefits? Am J Perinatol 2012;29:7-18.
3. Clark EA, Silver RM. Long-term maternal morbidity associated with repeat cesarean delivery. Am J Obstet Gynecol 2011;205: S2-10.
4. Keedle H, Schmied V, Burns E, Dahlen HG. From coercion to respectful care: women’s interactions with health care providers when planning a VBAC. BMC Pregnancy Childbirth 2022;22:70.
5. Basile Ibrahim B, Kennedy HP, Whittemore R. Women’s perceptions of barriers and facilitators to vaginal birth after cesarean in the United States: an integrative review. J Midwifery Womens Health 2020;65:349-61.
6. Chan MH, Hauck Y, Kuliukas L, Lewis L. Women’s experiences of their involvement in care decisions during a subsequent pregnancy after a previous caesarean birth in Western Australia. Women Birth 2021;34:e442-50.
7. World Health Organization. WHO statement on caesarean section rates. Geneva: World Health Organization; 2015:149-50
8. Betrán AP, Torloni MR, Zhang JJ, Gülmezoglu AM. WHO statement on caesarean section rates. BJOG 2016;123:667-70.
9. Tampakoudis P, Assimakopoulos E, Grimbizis G, Zafrakas M, Tampakoudis G, Mantalenakis S, et al. Cesarean section rates and indications in Greece: data from 24 years in a teaching hospital. Clin Exp Obstet Gynecol 2004;31:289-92.
10. Timofeev J, Reddy UM, Huang CC, Driggers RW, Landy HJ, Laughon SK. Obstetric complications, neonatal morbidity, and indications for cesarean delivery by maternal age. Obstet Gynecol 2013;122:1184-95.
11. Zaigham M, Varallo J, Thangaratinam S, Nicholson W, Visser GHA. Global disparities in caesarean section rates: why indication-based metrics are needed. PLOS Glob Public Health 2024;4:e0002877.
12. Betrán AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health 2021;6:e005671.
13. 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.
14. Fobelets M, Beeckman K, Faron G, Daly D, Begley C, Putman K. Vaginal birth after caesarean versus elective repeat caesarean delivery after one previous caesarean section: a cost-effectiveness analysis in four European countries. BMC Pregnancy Childbirth 2018;18:1-10.
15. Talaulikar VS, Arulkumaran S. Vaginal birth after caesarean section. Obstet Gynaecol Reprod Med 2015;25:195-202.
16. Panda S, Begley C, Daly D. Clinicians’ views of factors influencing decision-making for caesarean section: a systematic review and metasynthesis of qualitative, quantitative and mixed-methods studies. PLoS One 2018;13:e0200941.
17. Lundgren I, Begley C, Gross MM, Bondas T. Groping through the fog: a metasynthesis of women’s experiences on VBAC. BMC Pregnancy Childbirth 2012;12:1-11.
18. Chen HY, Blackwell SC, Chauhan SP. Association between Apgar score at 5 minutes and adverse outcomes among low-risk pregnancies. J Matern Fetal Neonatal Med 2022;35:1344-51.
19. Laughon SK, Zhang J, Troendle J, Sun L, Reddy UM. Using a simplified Bishop score to predict vaginal delivery. Obstet Gynecol 2011;117:805-11.
20. Macones GA, Peipert J, Nelson DB, Odibo A, Stevens EJ, Stamilio DM, et al. Maternal complications with vaginal birth after cesarean delivery: a multicenter study. Am J Obstet Gynecol 2005;193:1656-62.
21. Zhang J, Landy HJ, Branch DW, Burkman R, Haberman S, Gregory KD, et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol 2010;116:1281-7.
22. Guise JM, Eden K, Emeis C, Denman MA, Marshall N, Fu RR, et al. Vaginal birth after cesarean: new insights. Evid Rep Technol Assess 2010;191:1-397.
23. Cahill AG, Stamilio DM, Odibo AO, Peipert JF, Ratcliffe SJ, Stevens EJ, et al. Is vaginal birth after cesarean or elective repeat cesarean safer in women with a prior vaginal delivery? Am J Obstet Gynecol 2006;195:1143-7.
24. Young CB, Liu S, Muraca GM, Sabr Y, Pressey T, Liston RM, et al. Mode of delivery after a previous cesarean birth and associated maternal and neonatal morbidity. CMAJ 2018;190:E556-64.
25. Wingert A, Hartling L, Sebastianski M, Johnson C, Featherstone R, Vandermeer B, et al. Clinical interventions that influence vaginal birth after cesarean delivery rates: systematic review and meta-analysis. BMC Pregnancy Childbirth 2019;19:1-19.
26. Li WH, Yang MJ, Wang PH, Juang CM, Chang YW, Wang HI, et al. Vaginal birth after cesarean section: 10 years of experience in a tertiary medical center in Taiwan. Taiwan J Obstet Gynecol 2016;55:394-8.
27. Tilden EL, Cheyney M, Guise JM, Emeis C, Lapidus J, Biel FM, et al. Vaginal birth after cesarean: neonatal outcomes and United States birth setting. Am J Obstet Gynecol 2017;216:403.e1-8.
| Files | ||
| Issue | Vol 63 No 6 (2025) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/acta.v63i6.20680 | |
| Keywords | ||
| Vaginal birth after cesarean (VBAC) Trial of labor after cesarean | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Shooshtari M, Movahedi S, Tavakkolian S, Roshanzadeh G, Ghalenoee Z. Examining the Frequency of Complications of Vaginal Birth After Cesarean Delivery in Postpartum Time: A Retrospective Case-Series. Acta Med Iran. 2025;63(6):371-375.
