Vaginal Birth After Cesarean: Maternal and Fetal Outcomes in a Multicenter Study

Vaginal Birth After Cesarean: Maternal and Fetal Outcomes in a Multicenter Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Vaginal Birth After Cesarean: Maternal and Fetal Outcomes in a Multicenter Study Mehmet Nuri Duran, Serem Kel Ilgin, Süreyya Saridas Demir, Abdurrahman Sengi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7359663/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Vaginal birth after cesarean (VBAC) is widely regarded as a key approach to lowering unnecessary repeat cesarean rates while supporting safer, more cost-effective maternal care. Beyond aligning with a woman’s preference for vaginal delivery, VBAC offers significant health benefits — it can lower the risk of maternal complications, reduce the likelihood of problems in subsequent pregnancies, and contribute to an overall decline in population-level cesarean delivery rates. This study aimed to evaluate VBAC outcomes in high-fertility regions of Türkiye. Methods: This retrospective, multicenter observational study was conducted in four secondary-level hospitals located in high-fertility regions of Türkiye, including women with a history of one prior low-transverse cesarean section who attempted vaginal birth between January 2020 and May 2025. Maternal demographics, obstetric history, and delivery outcomes were compared between successful and unsuccessful VBAC attempts. Results: 342 participants of the 314 (91.8%) achieved successful VBAC. Higher Bishop scores and gestational age predicted success. Unsuccessful VBAC was associated with increased maternal morbidity, including uterine rupture and and blood transfusion requirements. Additionally, neonatal outcomes such as Apgar scores were less favorable in the unsuccessful VBAC group. Conclusions: VBAC success rates are high in selected patients, but careful candidate selection is essential to minimize complications. Our findings indicate that VBAC can achieve high success rates in appropriately selected patients, even in high-fertility regions. VBAC ERCS Vaginal Birth After Cesarean Maternal Outcomes Neonatal Outcomes Figures Figure 1 Figure 2 Introduction Worldwide, the incidence of cesarean section (CS) continues to rise over the past few decades. Particularly in high-income nations, concerns among health care workers as well as decision-makers have grown. Although cesarean deliveries are frequently performed in certain obstetric circumstances as a life-saving intervention, the exponential rise in numbers of operative deliveries may be associated with long-term maternal and neonatal sequelae due to the high rate of repeat procedures [ 1 ], [ 2 ]. When considering vaginal birth after cesarean, it is a complicated issue in women with previous cesarean section. After a previous cesarean section, women have two main options for their next birth: elective repeat cesarean section (ERCS) or vaginal birth after cesarean (VBAC) [ 3 ]. It is recommended by a number of international guidelines; among them, for example, the American College of Obstetricians and Gynecologists (ACOG) endorses VBAC as a safe option for women lacking contraindications who have a single prior low-transverse incision [ 4 ]. For the mother, VBAC delivers diverse benefits: faster recovery time; less chance of complications such as infection, excess blood loss, and future placenta accreta spectrum disease in subsequent pregnancies (Cosmai et al., 2025). For the child, in future pregnancies, it also can be a shield that wards off serious adverse perinatal outcomes [ 5 ]. Nonetheless, worries linger due to the low frequency and high severity of uterine rupture—which occurs in only about 0.5–0.9% of trial of labor after cesarean (TOLAC) attempts [ 6 ]. It is trying to balance the safety of mother and baby with patient preferences while at the same time taking into account medical facilities and their ability to handle emergencies. This in-depth examination of obstetric history, precise evaluation for any possible complications—such as uterine rupture—and ensuring availability of adequate resources when needed has to involve both patient and staff alike. In Turkey, the cesarean section (CS) rate has far surpassed global health guidelines and has become a significant public health problem. According to Ministry of Health data for 2022, 78.1% of all babies born in Turkey were delivered by CS [ 7 ]. putting our country first among nations surveyed. By comparison, these figures are more than 5-fold greater than the WHO’s suggested optimal level of 10–15% [ 8 ]. In this way, VBAC will not only be a clinical choice but also a public health undertaking to reduce the number of repeat cesareans and their potential hazards for lifelong well-being [ 2 ]. In view of such uncertainties, the present study will compare outcomes for mothers and babies between women who have a TOLAC versus those having an ERCS. By seeking context-specific up-to-date evidence, the study aims to provide guidance on clinical decision-making and safe, evidence-based planning for women with previous cesarean sections. Materials and methods Study design and data acquisition This retrospective observational study was conducted between January 2020 and May 2025 across four secondary-level public hospitals in Turkey: Midyat State Hospital, Çermik State Hospital, Akçakale State Hospital, and Ezine State Hospital. Collectively, these centers have an average annual birth volume of approximately 6,000, with Çermik, Akçakale, and Midyat located in provinces that rank those with the highest annual birth rates in the country. Maternal baseline clinical characteristics, intrapartum management, postpartum complications, and neonatal outcomes were analyzed. Maternal basic clinical information, intrapartum management, postpartum complications, and neonatal outcomes were viewed. The data used in this study were retrieved from hospital birth registries and archived patient medical records, which had been previously entered into the electronic system to ensure accuracy and completeness. Selection criteria singleton pregnancy, vertex presentation, one previous low-transverse cesarean section (LSCS) performed for a non-recurrent indication, gestational age ≥37 weeks confirmed by first-trimester ultrasound and menstrual history, and maternal age between 18 and 35 years. Exclusion criteria included a history of classical (vertical) uterine incision, fetal macrosomia (>4,500 g), Age 35 years, intrauterine fetal death, prior uterine surgery (e.g., myomectomy), and obstetric contraindications to vaginal delivery). A total of 538 women were initially assessed for eligibility. Of these, 197 were excluded due to missing data (n = 29), multiple pregnancies (n = 4), gestational age below 37 weeks (n = 86), or maternal age under 18 years (n = 11). Ultimately, 341 women met the inclusion criteria and were enrolled in the study. Among them, 314 achieved a successful VBAC, while 28 experienced a failed VBAC. (Figure 1) Figure 1 here Statistical analysis All analyses were performed using SPSS software (version 25.0; IBM Corp., Armonk, NY, USA). Descriptive statistics were presented as mean ± standard deviation (SD) for continuous variables and as frequencies (percentages) for categorical variables. Comparisons between groups were conducted using the Chi-square test for categorical variables and the independent samples t-test for continuous variables. A p-value < 0.05 was considered statistically significant. Predictive performance for VBAC success was evaluated using receiver operating characteristic (ROC) curve analysis. Ethical approval Ethical approval for the study was granted by the Mardin Provincial Health Directorate (Approval No: E-68051626-949-206470075, Date: 06/01/2023). The research was conducted in accordance with the principles outlined in the Declaration of Helsinki. Permission to access anonymized (non-identifiable) data was obtained from the hospital board of directors. Results A total of 342 women met the inclusion criteria for the study. Among them, 314 (91.8%) achieved a successful VBAC, whereas 28 (8.2%) underwent emergency cesarean delivery following a failed VBAC attempt. Maternal characteristics were comparated between the two groups. No significant differences were observed in mean maternal age (24.53 ± 3.13 vs. 23.96 ± 3.01 years, p = 0.36) or body mass index (23.69 ± 2.60 vs. 23.06 ± 2.76 kg/m², p = 0.35). However, gestational age at delivery was significantly greater in the successful VBAC group compared with those who required emergency cesarean delivery (38.56 ± 1.23 vs. 38.00 ± 1.03 weeks, p = 0.01). Likewise, the mean Bishop score on admission was markedly higher in the successful VBAC group (6.22 ± 0.54 vs. 3.96 ± 0.96, p < 0.01). Neonatal 5-minute Apgar scores were also significantly better among successful VBAC cases (9.26 ± 0.45 vs. 8.71 ± 0.71, p < 0.01). There was no statistically significant difference in mean birth weight between the groups (3410.02 ± 450.77 g vs. 3365.57 ± 440.72 g, p = 0.61). (Table 1). Table 1 here Regarding obstetric and neonatal outcomes, the incidence of uterine rupture was significantly higher among women with failed VBAC (0.9% vs. 3.0%, p < 0.001). The requirement for blood transfusion was also greater in this group (4.1% vs. 14.2%, p = 0.02). While the frequency of intrauterine growth restriction (IUGR) was slightly higher in the failed VBAC group, the difference did not reach statistical significance (7.9% vs. 10.7%, p = 0.06). In contrast, the proportion of neonates with an umbilical artery pH < 7 was significantly higher among failed VBAC cases (1.2% vs. 3.5%, p = 0.02). The rates of labor induction were similar in both groups (27% vs. 25%, p = 0.80). (Table 2) Table 2 here Decision curve analysis Receiver operating characteristic (ROC) curve analysis demonstrated that the predictive model had a good ability to discriminate between successful and failed VBAC outcomes, with an area under the curve (AUC) of 0.770 (95% CI: 0.68–0.85). (Figure 2) Figure 2 here Discussion This study evaluated VBAC attempts conducted in hospitals located in regions of Turkey with high fertility rates. Our findings revealed a VBAC success rate of 91.8%. This rate is notably higher than the 56% success rate reported by Tegegne et al. in their clinical setting (Tegegne, Rade, Yismaw, Taye, & Mengistie, 2024) [9]. This difference may be attributed to recent national and institutional efforts to promote normal vaginal delivery, along with evolving obstetric practices that support VBAC. In the successful VBAC group, the incidence of uterine rupture was 0.9%, compared to 3% in the failed VBAC group. Although the higher rate in the failed group was statistically significant, it may have been influenced by the relatively small sample size. While uterine rupture rates are typically reported around 0.5% in the literature [10], the higher incidence in our cohort may be explained by the fact that all participants had intrinsic risk factors for rupture. The need for blood transfusion was 4.1% in the successful VBAC group and 14.2% in the failed group, indicating a significantly greater requirement in failed VBACs. Our transfusion rates are higher than those reported in previous studies [11]. These discrepancies may reflect differences in the study population, rates of labor induction, and variations in obstetric care standards. Our analysis also identified the Bishop score as an important predictor of VBAC success. Receiver operating characteristic (ROC) analysis showed a significant predictive capacity (AUC = 0.85), consistent with prior studies supporting the Bishop score as a clinically valuable tool in labor management [12], [13]. Furthermore, gestational age was found to be positively associated with VBAC success. This may be explained by increased cervical ripeness and spontaneous onset of labor at later gestational weeks. Similar results have been reported in previous research, particularly noting higher VBAC success rates at term [14]. In conclusion, VBAC attempts are associated with high success rates; however, failed attempts carry a markedly increased risk of maternal morbidity. Therefore, incorporating predictive factors such as the Bishop score and gestational age into candidate selection is crucial to safeguarding both maternal and neonatal health. Conclusions Klinik pratiğimizde, daha önce sezaryen doğum yapmış kadınların sıklıkla doğum ağrısının yönetimi konusunda endişe duydukları ve bunun doğum şekli tercihlerini etkilediği gözlemlenmektedir. VBAC için takip edilen her hastanın anamnezi dikkatlice alınmalıdır. Tools that use factors such as body mass index (BMI), any previous vaginal births, the time between pregnancies, and the condition of the cervix can help healthcare providers estimate how likely a woman is to have a successful VBAC. Güvenli VBAC’nin teşvik edilmesi ve kolaylaştırılması, bir halk sağlığı önceliği oluşturmaktadır. Gereksiz tekrarlayan sezaryen doğumların azaltılması, maternal ve neonatal sonuçların iyileştirilmesine ve sağlık hizmeti kaynaklarının daha sürdürülebilir kullanımına katkı sağlayabilir [15]. Reflecting both institutional practices and societal preferences that strongly supporting vaginal delivery. This trend not only increases healthcare costs but also contributes to the rising burden of repeat cesarean sections and their associated maternal and neonatal risks [16]. Abbreviations TOLAC Trial of Labor After Cesarean VBAC Vaginal Birth After Cesarean ACOG American College of Obstetricians and Gynecologists BMI Body Mass Index ERCS elective repeat cesarean section LSCS low-transverse cesarean section IUGR intrauterine growth restriction CS Caesarean Section CD Cesarean Delivery SD Standard deviation ROC Receiver operating characteristic Declarations Ethics approval and consent to participate The Scientific Research Ethics Committee of the Provincial Directorate of Health approved the study and analysis plan (approval number: E-68051626-949-206470075, date: 06 January 2023). Since the study was designed as a retrospective analysis, the Ethics Committee did not consider it necessary to obtain informed consent. Accordingly, no informed consent was obtained from the patients; all data were de-identified and handled with strict confidentiality. Consent for publication Not applicable. Availability of data and materials The datasets used and analyzed during the current study are available from the corresponding author on reasonable request Competing interests The authors declare that they have no competing interests. Funding The funding sources had no role in the study design, data collection, data analysis, data interpretation, or preparation of the manuscript. Authors' contributions MND designed the study, acquired the data, lead the analysis and interpretation of data, and drafting of the manuscript. SKI and AS contributed to the analysis, interpretation of data and data handling, SSD and BD contributed to the analysis and interpretation of the data, and drafting and critically revising the manuscript. All authors read and approved the final manuscript. Acknowledgement The authors would like to thank all the study participants. References Boerma T, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. Oct. 2018;392(10155):1341–8. 10.1016/S0140-6736(18)31928-7 . Sandall J, et al. Short-term and long-term effects of caesarean section on the health of women and children. Lancet. Oct. 2018;392(10155):1349–57. 10.1016/S0140-6736(18)31930-5 . Qiu L, Zhu J, Lu X. The safety of trial of labor after cesarean section (TOLAC) versus elective repeat cesarean section (ERCS): a systematic review and meta-analysis. J Maternal-Fetal Neonatal Med. Dec. 2023;36(1). 10.1080/14767058.2023.2214831 . ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery. Obstet Gynecol. Feb. 2019;133(2):e110–27. 10.1097/AOG.0000000000003078 . Morlando M, Collins S, Placenta Accreta Spectrum Disorders: Challenges, Risks, and Management Strategies,. 2020, doi: 10.2147/IJWH.S224191 . L. A. Choi, A. A. Chung, B. Pierce Late Presentation of Uterine Rupture Following Vaginal Birth After Cesarean Delivery: A Case Report. Am J Perinatol Rep, 10, 03, e300–3, Jul. 2020, doi: 10.1055/s-0040-1715175. G. Topaktaş, U. Beylik, Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi , 21, 2, pp. 102–113, Jun. 2024, doi: 10.38136/jgon.1482889. J. Wladimiroff, S. Tsiapakidou, T. Mahmood, P. Velebil Caesarean section rates across Europe and its impact on specialist training in Obstetrics: A qualitative review by the Standing Committee of Hospital Visiting Programme for Training Recognition of the European Board and College of the Obstetrics and Gynaecology (EBCOG). European Journal of Obstetrics & Gynecology and Reproductive Biology, 304, 77–83, Jan. 2025, doi: 10.1016/j.ejogrb.2024.10.044. G. A. Tegegne, B. K. Rade, A. E. Yismaw, W. Taye, B. A. Mengistie Predictors of successful trial of labor after cesarean section (TOLAC) in women with one prior transverse cesarean section at Tertiary Hospitals in northwest Ethiopia: a multicenter study.BMC Pregnancy Childbirth, 24, 1,240, Apr. 2024, doi: 10.1186/s12884-024-06432-z. L. A. Choi, A. A. Chung, B. Pierce Late Presentation of Uterine Rupture Following Vaginal Birth After Cesarean Delivery: A Case Report.American Journal of Perinatology Reports, 10, 03,e300–e303, Jul. 2020, doi: 10.1055/s-0040-1715175. J. M. Phillips, D. Polyakov, R. L. Amdur, H. K. Ahmadzia, Trial of labor after cesarean: Maternal and neonatal outcomes from the Consortium on Safe Labor, J Neonatal Perinatal Med , 17, 1, pp. 1–5, Mar 2024, doi: 10.3233/NPM-230009. A. Michail, Z. Fasoulakis, E. Domali, G. Daskalakis, P. Antsaklis Role of the Bishop Score in Predicting Successful Induction of Vaginal Delivery: A Systematic Review of Current Evidence. Cureus , Jul. 2025, doi: 10.7759/cureus.87467. I. Krishna Chaaithanya, Y. Mujumdar, M. Anwesh, C. Aranha, Novel genotypes of vaginal Candida glabrata isolates from premenopausal asymptomatic women with vulvovaginitis, European Journal of Obstetrics & Gynecology and Reproductive Biology , 276, pp. 249–250, Sep 2022, doi: 10.1016/j.ejogrb.2022.07.012. Y. Wu, Y. Kataria, Z. Wang, W.-K. Ming, C. Ellervik Factors associated with successful vaginal birth after a cesarean section: a systematic review and meta-analysis.BMC Pregnancy Childbirth, 19, 1,360, Dec. 2019, doi: 10.1186/s12884-019-2517-y. 205: Vaginal Birth After Cesarean Delivery.Obstetrics & Gynecology, 133, 2,e110–e127, Feb. 2019, doi: 10.1097/AOG.0000000000003078. N. E. Marshall, R. Fu, J.-M. Guise, Impact of multiple cesarean deliveries on maternal morbidity: a systematic review, Am J Obstet Gynecol , 205, 3, pp. 262.e1-262.e8, Sep 2011, doi: 10.1016/j.ajog.2011.06.035. Tables Table 1. Demographic characteristics of women undergoing trial of labour After Cesarean (chi-square and Student’s t-test as appropriate) . VBAC: Vaginal Birth After Cesarean, SD: Standard deviation Succesful VBAC Mean ± SD Failed VBAC Mean ± SD p Maternal Age (yrs) 24.53 ± 3.13 23.96 ± 3.01 0.36 BMI(kg/m2) 23.69 ± 2.60 23.06 ± 2.76 0.35 Gestational Age (weeks) 38.56 ± 1.23 38.00 ± 1.03 0.01 Bishop score 6.22 ± 0.54 3.96 ± 0.96 0.00 5th MinuteApgar 9.26 ± 0.45 8.71 ± 0.71 0.00 Birth Weight (g) 3410.02 ± 450.77 3365.57 ± 440.72 0.61 Table 2 . Clinical Features of Women Undergoing Trial of Labor After Cesarean (Chi-Square and Student’s t-Test as Appropriate) IUGR: intrauterine growth restriction. VBAC: Vaginal Birth After Cesarean Succesful VBAC n:314 (%) Failed VBAC n:28 (%) p Uterine rupture 3 (0.9 ) 1 (3) 0.01 Blood Transfusion 13 (4.1 ) 4 (14.2) 0.02 IUGR 25 (7.9) 3 (10.7) 0.06 Umbilical artery pH <7 4 (1.2) 1 (3.5) 0.02 Induced labor 87 (27) 7 (25) 0.8 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7359663","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":521855692,"identity":"5b3cbe64-9c63-4dcc-bb1b-6540d47ba397","order_by":0,"name":"Mehmet Nuri 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10:58:23","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":53030,"visible":true,"origin":"","legend":"","description":"","filename":"ac30731545474cc0b5523b40955d22661structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7359663/v1/dcb6561baeec9ed69bb49312.xml"},{"id":92499335,"identity":"dca62022-e2fe-4b60-bcfc-64f5fe6f5607","added_by":"auto","created_at":"2025-09-30 10:58:23","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":60226,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7359663/v1/ba231da0af70dab824a7754c.html"},{"id":92499321,"identity":"70d7c1ea-ec67-4e15-b3d0-94a3ae6a7349","added_by":"auto","created_at":"2025-09-30 10:58:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":34141,"visible":true,"origin":"","legend":"\u003cp\u003eStrengthening the Reporting of Observational Studies in Epidemiology (STROBE). Flow diagram of patients recruitment.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7359663/v1/2834a2ae4617baf2293421b2.png"},{"id":92499532,"identity":"881ae2d9-aade-43df-9c55-254dd79c9f73","added_by":"auto","created_at":"2025-09-30 11:06:23","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":107410,"visible":true,"origin":"","legend":"\u003cp\u003eROC Curve s for predictors of VBAC success\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7359663/v1/bab714d55f47f04cbfc975a7.png"},{"id":94472936,"identity":"eef7bf61-594e-4445-ba19-7c6860e869e3","added_by":"auto","created_at":"2025-10-27 15:42:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":673026,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7359663/v1/d7132068-faa6-463d-af03-cb09017570c4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Vaginal Birth After Cesarean: Maternal and Fetal Outcomes in a Multicenter Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWorldwide, the incidence of cesarean section (CS) continues to rise over the past few decades. Particularly in high-income nations, concerns among health care workers as well as decision-makers have grown. Although cesarean deliveries are frequently performed in certain obstetric circumstances as a life-saving intervention, the exponential rise in numbers of operative deliveries may be associated with long-term maternal and neonatal sequelae due to the high rate of repeat procedures [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. When considering vaginal birth after cesarean, it is a complicated issue in women with previous cesarean section. After a previous cesarean section, women have two main options for their next birth: elective repeat cesarean section (ERCS) or vaginal birth after cesarean (VBAC) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It is recommended by a number of international guidelines; among them, for example, the American College of Obstetricians and Gynecologists (ACOG) endorses VBAC as a safe option for women lacking contraindications who have a single prior low-transverse incision [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. For the mother, VBAC delivers diverse benefits: faster recovery time; less chance of complications such as infection, excess blood loss, and future placenta accreta spectrum disease in subsequent pregnancies (Cosmai et al., 2025). For the child, in future pregnancies, it also can be a shield that wards off serious adverse perinatal outcomes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Nonetheless, worries linger due to the low frequency and high severity of uterine rupture\u0026mdash;which occurs in only about 0.5\u0026ndash;0.9% of trial of labor after cesarean (TOLAC) attempts [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. It is trying to balance the safety of mother and baby with patient preferences while at the same time taking into account medical facilities and their ability to handle emergencies. This in-depth examination of obstetric history, precise evaluation for any possible complications\u0026mdash;such as uterine rupture\u0026mdash;and ensuring availability of adequate resources when needed has to involve both patient and staff alike.\u003c/p\u003e\u003cp\u003e In Turkey, the cesarean section (CS) rate has far surpassed global health guidelines and has become a significant public health problem. According to Ministry of Health data for 2022, 78.1% of all babies born in Turkey were delivered by CS [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. putting our country first among nations surveyed. By comparison, these figures are more than 5-fold greater than the WHO\u0026rsquo;s suggested optimal level of 10\u0026ndash;15% [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In this way, VBAC will not only be a clinical choice but also a public health undertaking to reduce the number of repeat cesareans and their potential hazards for lifelong well-being [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn view of such uncertainties, the present study will compare outcomes for mothers and babies between women who have a TOLAC versus those having an ERCS. By seeking context-specific up-to-date evidence, the study aims to provide guidance on clinical decision-making and safe, evidence-based planning for women with previous cesarean sections.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and data acquisition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective observational study was conducted between January 2020 and May 2025 across four secondary-level public hospitals in Turkey: Midyat State Hospital, Çermik State Hospital, Akçakale State Hospital, and Ezine State Hospital. Collectively, these centers have an average annual birth volume of approximately 6,000, with Çermik, Akçakale, and Midyat located in provinces that rank those with the highest annual birth rates in the country. Maternal baseline clinical characteristics, intrapartum management, postpartum complications, and neonatal outcomes were analyzed.\u0026nbsp;Maternal basic clinical information, intrapartum management, postpartum complications, and neonatal outcomes were viewed.\u0026nbsp;The data used in this study were retrieved from hospital birth registries and archived patient medical records, which had been previously entered into the electronic system to ensure accuracy and completeness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSelection criteria\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cbr\u003esingleton pregnancy, vertex presentation, one previous low-transverse cesarean section (LSCS) performed for a non-recurrent indication, gestational age ≥37 weeks confirmed by first-trimester ultrasound and menstrual history, and maternal age between 18 and 35 years. \u003cstrong\u003eExclusion criteria\u003c/strong\u003e included a history of classical (vertical) uterine incision, fetal macrosomia (\u0026gt;4,500 g), Age \u0026lt;18 years or \u0026gt;35 years, intrauterine fetal death, prior uterine surgery (e.g., myomectomy), and obstetric contraindications to vaginal delivery). A total of 538 women were initially assessed for eligibility. Of these, 197 were excluded due to missing data (n = 29), multiple pregnancies (n = 4), gestational age below 37 weeks (n = 86), or maternal age under 18 years (n = 11). Ultimately, 341 women met the inclusion criteria and were enrolled in the study. Among them, 314 achieved a successful VBAC, while 28 experienced a failed VBAC. (Figure 1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 1 here\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll analyses were performed using SPSS software (version 25.0; IBM Corp., Armonk, NY, USA). Descriptive statistics were presented as mean ± standard deviation (SD) for continuous variables and as frequencies (percentages) for categorical variables. Comparisons between groups were conducted using the Chi-square test for categorical variables and the independent samples t-test for continuous variables. A p-value \u0026lt; 0.05 was considered statistically significant. Predictive performance for VBAC success was evaluated using receiver operating characteristic (ROC) curve analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for the study was granted by the Mardin Provincial Health Directorate (Approval No: E-68051626-949-206470075, Date: 06/01/2023). The research was conducted in accordance with the principles outlined in the Declaration of Helsinki. Permission to access anonymized (non-identifiable) data was obtained from the hospital board of directors.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 342 women met the inclusion criteria for the study. Among them, 314 (91.8%) achieved a successful VBAC, whereas 28 (8.2%) underwent emergency cesarean delivery following a failed VBAC attempt.\u003c/p\u003e\n\u003cp\u003eMaternal characteristics were comparated between the two groups. No significant differences were observed in mean maternal age (24.53 \u0026plusmn; 3.13 vs. 23.96 \u0026plusmn; 3.01 years, p = 0.36) or body mass index (23.69 \u0026plusmn; 2.60 vs. 23.06 \u0026plusmn; 2.76 kg/m\u0026sup2;, p = 0.35). However, gestational age at delivery was significantly greater in the successful VBAC group compared with those who required emergency cesarean delivery (38.56 \u0026plusmn; 1.23 vs. 38.00 \u0026plusmn; 1.03 weeks, p = 0.01). Likewise, the mean Bishop score on admission was markedly higher in the successful VBAC group (6.22 \u0026plusmn; 0.54 vs. 3.96 \u0026plusmn; 0.96, p \u0026lt; 0.01). Neonatal 5-minute Apgar scores were also significantly better among successful VBAC cases (9.26 \u0026plusmn; 0.45 vs. 8.71 \u0026plusmn; 0.71, p \u0026lt; 0.01). There was no statistically significant difference in mean birth weight between the groups (3410.02 \u0026plusmn; 450.77 g vs. 3365.57 \u0026plusmn; 440.72 g, p = 0.61). (Table 1).\u003c/p\u003e\n\u003cp\u003eTable 1 here\u003c/p\u003e\n\u003cp\u003eRegarding obstetric and neonatal outcomes, the incidence of uterine rupture was significantly higher among women with failed VBAC (0.9% vs. 3.0%, p \u0026lt; 0.001). The requirement for blood transfusion was also greater in this group (4.1% vs. 14.2%, p = 0.02). While the frequency of intrauterine growth restriction (IUGR) was slightly higher in the failed VBAC group, the difference did not reach statistical significance (7.9% vs. 10.7%, p = 0.06). In contrast, the proportion of neonates with an umbilical artery pH \u0026lt; 7 was significantly higher among failed VBAC cases (1.2% vs. 3.5%, p = 0.02). The rates of labor induction were similar in both groups (27% vs. 25%, p = 0.80). (Table 2)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 here\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDecision curve analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eReceiver operating characteristic (ROC) curve analysis demonstrated that the predictive model had a good ability to discriminate between successful and failed VBAC outcomes, with an area under the curve (AUC) of 0.770 (95% CI: 0.68\u0026ndash;0.85). (Figure 2)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 2 here\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated VBAC attempts conducted in hospitals located in regions of Turkey with high fertility rates. Our findings revealed a VBAC success rate of 91.8%. This rate is notably higher than the 56% success rate reported by Tegegne et al. in their clinical setting (Tegegne, Rade, Yismaw, Taye, \u0026amp; Mengistie, 2024)\u0026nbsp;[9]. This difference may be attributed to recent national and institutional efforts to promote normal vaginal delivery, along with evolving obstetric practices that support VBAC.\u003c/p\u003e\n\u003cp\u003eIn the successful VBAC group, the incidence of uterine rupture was 0.9%, compared to 3% in the failed VBAC group. Although the higher rate in the failed group was statistically significant, it may have been influenced by the relatively small sample size. While uterine rupture rates are typically reported around 0.5% in the literature\u0026nbsp;[10], the higher incidence in our cohort may be explained by the fact that all participants had intrinsic risk factors for rupture. The need for blood transfusion was 4.1% in the successful VBAC group and 14.2% in the failed group, indicating a significantly greater requirement in failed VBACs. Our transfusion rates are higher than those reported in previous studies [11]. These discrepancies may reflect differences in the study population, rates of labor induction, and variations in obstetric care standards. Our analysis also identified the Bishop score as an important predictor of VBAC success. Receiver operating characteristic (ROC) analysis showed a significant predictive capacity (AUC = 0.85), consistent with prior studies supporting the Bishop score as a clinically valuable tool in labor management [12], [13].\u003c/p\u003e\n\u003cp\u003eFurthermore, gestational age was found to be positively associated with VBAC success. This may be explained by increased cervical ripeness and spontaneous onset of labor at later gestational weeks. Similar results have been reported in previous research, particularly noting higher VBAC success rates at term [14]. In conclusion, VBAC attempts are associated with high success rates; however, failed attempts carry a markedly increased risk of maternal morbidity. Therefore, incorporating predictive factors such as the Bishop score and gestational age into candidate selection is crucial to safeguarding both maternal and neonatal health.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eKlinik pratiğimizde, daha \u0026ouml;nce sezaryen doğum yapmış kadınların sıklıkla doğum ağrısının y\u0026ouml;netimi konusunda endişe duydukları ve bunun doğum şekli tercihlerini etkilediği g\u0026ouml;zlemlenmektedir. VBAC i\u0026ccedil;in takip edilen her hastanın anamnezi dikkatlice alınmalıdır. Tools that use factors such as body mass index (BMI), any previous vaginal births, the time between pregnancies, and the condition of the cervix can help healthcare providers estimate how likely a woman is to have a successful VBAC. G\u0026uuml;venli VBAC\u0026rsquo;nin teşvik edilmesi ve kolaylaştırılması, bir halk sağlığı \u0026ouml;nceliği oluşturmaktadır. Gereksiz tekrarlayan sezaryen doğumların azaltılması, maternal ve neonatal sonu\u0026ccedil;ların iyileştirilmesine ve sağlık hizmeti kaynaklarının daha s\u0026uuml;rd\u0026uuml;r\u0026uuml;lebilir kullanımına katkı sağlayabilir [15]. Reflecting both institutional practices and societal preferences that strongly supporting vaginal delivery. This trend not only increases healthcare costs but also contributes to the rising burden of repeat cesarean sections and their associated maternal and neonatal risks [16].\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTOLAC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTrial of Labor After Cesarean\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eVBAC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eVaginal Birth After Cesarean\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eACOG\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAmerican College of Obstetricians and Gynecologists\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBody Mass Index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eERCS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eelective repeat cesarean section\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLSCS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003elow-transverse cesarean section\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIUGR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eintrauterine growth restriction\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCaesarean Section\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCesarean Delivery\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandard deviation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eROC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eReceiver operating characteristic\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Scientific Research Ethics Committee of the Provincial Directorate of Health approved the study and analysis plan (approval number: E-68051626-949-206470075, date: 06 January 2023). Since the study was designed as a retrospective analysis, the Ethics Committee did not consider it necessary to obtain informed consent. Accordingly, no informed consent was obtained from the patients; all data were de-identified and handled with strict confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe funding sources had no role in the study design, data collection, data analysis, data interpretation, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMND designed the study, acquired the data, lead the analysis and interpretation of data, and drafting of the manuscript. SKI and AS contributed to the analysis, interpretation of data and data handling, SSD and BD contributed to the analysis and interpretation of the data, and drafting and critically revising the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all the study participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBoerma T, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. Oct. 2018;392(10155):1341\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(18)31928-7\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(18)31928-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSandall J, et al. 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Mengistie Predictors of successful trial of labor after cesarean section (TOLAC) in women with one prior transverse cesarean section at Tertiary Hospitals in northwest Ethiopia: a multicenter study.BMC Pregnancy Childbirth, 24, 1,240, Apr. 2024, doi: 10.1186/s12884-024-06432-z.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eL. A. Choi, A. A. Chung, B. Pierce Late Presentation of Uterine Rupture Following Vaginal Birth After Cesarean Delivery: A Case Report.American Journal of Perinatology Reports, 10, 03,e300\u0026ndash;e303, Jul. 2020, doi: 10.1055/s-0040-1715175.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJ. M. Phillips, D. Polyakov, R. L. Amdur, H. K. Ahmadzia, Trial of labor after cesarean: Maternal and neonatal outcomes from the Consortium on Safe Labor, \u003cem\u003eJ Neonatal Perinatal Med\u003c/em\u003e, 17, 1, pp. 1\u0026ndash;5, Mar 2024, doi: 10.3233/NPM-230009.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eA. Michail, Z. Fasoulakis, E. Domali, G. Daskalakis, P. Antsaklis Role of the Bishop Score in Predicting Successful Induction of Vaginal Delivery: A Systematic Review of Current Evidence.\u003cem\u003eCureus\u003c/em\u003e, Jul. 2025, doi: 10.7759/cureus.87467.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eI. Krishna Chaaithanya, Y. Mujumdar, M. Anwesh, C. Aranha, Novel genotypes of vaginal Candida glabrata isolates from premenopausal asymptomatic women with vulvovaginitis, \u003cem\u003eEuropean Journal of Obstetrics \u0026amp; Gynecology and Reproductive Biology\u003c/em\u003e, 276, pp. 249\u0026ndash;250, Sep 2022, doi: 10.1016/j.ejogrb.2022.07.012.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eY. Wu, Y. Kataria, Z. Wang, W.-K. Ming, C. Ellervik Factors associated with successful vaginal birth after a cesarean section: a systematic review and meta-analysis.BMC Pregnancy Childbirth, 19, 1,360, Dec. 2019, doi: 10.1186/s12884-019-2517-y.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e205: Vaginal Birth After Cesarean Delivery.Obstetrics \u0026amp; Gynecology, 133, 2,e110\u0026ndash;e127, Feb. 2019, doi: 10.1097/AOG.0000000000003078.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eN. E. Marshall, R. Fu, J.-M. Guise, Impact of multiple cesarean deliveries on maternal morbidity: a systematic review, \u003cem\u003eAm J Obstet Gynecol\u003c/em\u003e, 205, 3, pp. 262.e1-262.e8, Sep 2011, doi: 10.1016/j.ajog.2011.06.035.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Demographic characteristics of women undergoing trial of labour After Cesarean (chi-square and Student\u0026rsquo;s t-test as appropriate)\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVBAC: Vaginal Birth After Cesarean, SD: Standard deviation\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuccesful VBAC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFailed VBAC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMaternal Age\u003c/p\u003e\n \u003cp\u003e(yrs)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e24.53 \u0026plusmn; 3.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e23.96 \u0026plusmn; 3.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBMI(kg/m2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e23.69 \u0026plusmn; 2.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e23.06 \u0026plusmn; 2.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eGestational Age (weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e38.56 \u0026plusmn; 1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e38.00 \u0026plusmn; 1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBishop score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e6.22 \u0026plusmn; 0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e3.96 \u0026plusmn; 0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5th MinuteApgar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e9.26 \u0026plusmn; 0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e8.71 \u0026plusmn; 0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBirth Weight (g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e3410.02 \u0026plusmn; 450.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e3365.57 \u0026plusmn; 440.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e. Clinical Features of Women Undergoing Trial of Labor After Cesarean (Chi-Square and Student\u0026rsquo;s t-Test as Appropriate) IUGR: intrauterine growth restriction.\u003c/p\u003e\n\u003cp\u003eVBAC: Vaginal Birth After Cesarean\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuccesful VBAC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en:314 (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFailed VBAC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en:28 (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eUterine rupture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e3 (0.9 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBlood Transfusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e13 (4.1 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e4 \u0026nbsp;(14.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eIUGR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e25 (7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e3 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eUmbilical artery pH \u0026lt;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e4 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eInduced labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e87 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e7 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"VBAC, ERCS, Vaginal Birth After Cesarean, Maternal Outcomes, Neonatal Outcomes","lastPublishedDoi":"10.21203/rs.3.rs-7359663/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7359663/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Vaginal birth after cesarean (VBAC) is widely regarded as a key approach to lowering unnecessary repeat cesarean rates while supporting safer, more cost-effective maternal care. Beyond aligning with a woman’s preference for vaginal delivery, VBAC offers significant health benefits — it can lower the risk of maternal complications, reduce the likelihood of problems in subsequent pregnancies, and contribute to an overall decline in population-level cesarean delivery rates. This study aimed to evaluate VBAC outcomes in high-fertility regions of Türkiye.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This retrospective, multicenter observational study was conducted in four secondary-level hospitals located in high-fertility regions of Türkiye, including women with a history of one prior low-transverse cesarean section who attempted vaginal birth between January 2020 and May 2025. Maternal demographics, obstetric history, and delivery outcomes were compared between successful and unsuccessful VBAC attempts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e 342 participants of the 314 (91.8%) achieved successful VBAC. Higher Bishop scores and gestational age predicted success. Unsuccessful VBAC was associated with increased maternal morbidity, including uterine rupture and and blood transfusion requirements. Additionally, neonatal outcomes such as Apgar scores were less favorable in the unsuccessful VBAC group. \u003cbr\u003e\n \u003cstrong\u003eConclusions:\u003c/strong\u003e VBAC success rates are high in selected patients, but careful candidate selection is essential to minimize complications. Our findings indicate that VBAC can achieve high success rates in appropriately selected patients, even in high-fertility regions.\u003c/p\u003e","manuscriptTitle":"Vaginal Birth After Cesarean: Maternal and Fetal Outcomes in a Multicenter Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-30 10:58:18","doi":"10.21203/rs.3.rs-7359663/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"344281db-0e07-4d4d-9b87-ca5eeb3e6634","owner":[],"postedDate":"September 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-27T14:26:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-30 10:58:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7359663","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7359663","identity":"rs-7359663","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}