Factors influencing the success of trial of labor after one previous caesarean section in a secure inter-delivery interval at Panzi Hospital.

Background: In middle- and low-income countries, the inter-delivery interval is an important parameter considered in the decision of TOLAC. The objective of this study is to determine influencing factors for success of trial of labor after cesarean in women with secure inter-delivery interval after a cesarean-section at a referral hospital. Methods: : A cross-sectional study was conducted at Panzi hospital on 231 cases in one year period. Women with one previous cesarean section, an inter-delivery interval space at least 18 months and no contracted pelvis were included. A successful TOLAC was defined as vaginal delivery and failed if cesarean section after trial of labor. Chi-square univariate testing and multi-variate logistic regression were used to understand the relationship between influencing factors the recorded variables and successful TOLAC, with a significance threshold of 5%. Results: : 57.6% (133 cases) successfully completed TOLAC with vaginal delivery. Many obstetric factors have a significant effect on success of TOLAC. middle cervix was likely to increase success of TOLAC by 61.50 times (OR=61.50, p-value=0.000). Cervical softening was likely to increase success of TOLAC by 5.96 times (OR=5.96, p-value=0.001). Active labor was likely to increase success of TOLAC by 7.79 times (OR=7.79, p-value=0.013). Uterine height also has a significant effect such that every centimeter increase in uterine height decreased likelihood of successful TOLAC by about half (OR= 0.62, p-value=0.000). Every unit increase in Apgar score in the 1st minute after birth increased likelihood of successful TOLAC by 1.71 times (OR=1.71, p-value=0.010). For every increase in parity, the likelihood of successful TOLAC increases by 1.30 (OR=1.30, p-value=0.031). The remaining obstetric factors in the model had no significant effect on success of TOLAC. Conclusions: : Our study shows that within a secure inter-delivery interval, high parity, uterine height less than 34 cm, active labor and cervical parameters such as cervical softening and middle cervix are important contributing factors to the success of TOLAC and VBAC. These factors should be considered by practitioners to influence their decision making regarding TOLAC.