“Predictors of failed vaginal birth after cesarean and associated maternal and neonatal outcomes: a case control study”

BACKGROUND: Vaginal Birth After Cesarean is a clinical measure that can reduce repeated cesarean deliveries, improve perinatal outcomes and shorten hospital stays. However, successful practice of Vaginal Birth After Cesarean remains restricted in the Middle East due to limited regional-specific guidelines. This study aimed to identify the predictors and maternal and neonatal outcomes of failed Vaginal Birth After Cesarean among a group of Middle Eastern women. METHODS: A retrospective case-control design was conducted between January 2023 and February 2024 across three hospitals in Oman. The case group involved failed Vaginal Birth After Cesarean requiring repeat cesarean, while the control group comprised successful Vaginal Birth After Cesarean. Descriptive and inferential statistics were used. Additionally, logistic regression analysis was conducted to identify significant predictors of failed vaginal birth after cesarean. RESULTS: Data of 364 participants were analyzed. The predictors of Vaginal Birth After Cesarean failure were high body mass index (32.66 ± 7.53; p < .001), low parity (median = 1; p < .001), low cervical dilation (2 cm vs. 4 cm; p < .001), obstetric complications (42.6% vs. 29.2%; p = .010), and meconium-stained amniotic fluid (16.3% vs. 6.9%; p = .006). Postpartum hemorrhage (21.6% vs. 4.6%; p < .001), scar tenderness (11.5% vs. 0.5%; p < .001), and low APGAR scores (p < .001) were more common in the case group. CONCLUSIONS: The study findings advance the regional literature with critical information supporting the development of standardized Middle Eastern specific Vaginal Birth After Cesarean guidelines. Higher body mass index, lower parity, lower cervical dilation at admission, meconium-stained amniotic fluid, and obstetric complications are significant predictors of Vaginal Birth After Cesarean failure. A failed Vaginal Birth After Cesarean attempt may increase the risks of post-partum hemorrhage, scar tenderness, and lower APGAR scores. Future research may prioritize prospective multicenter studies across diverse regions of the Middle East to validate the Vaginal Birth After Cesarean predictive variables.