OUTCOMES OF VAGINAL BIRTH AFTER CAESAREAN SECTION (VBAC) AT THE JARAMOGI OGINGA ODINGA TEACHING AND REFERRAL HOSPITAL, KENYA

Abstract

Cesarean section has been on the rise in the recent decades regardless of WHO (WORLD HEALTH ORGANIZATION) recommended rate of 15%. As a result, the question of how to manage subsequent deliveries become significant. There is an increase rate of repeat CS deliveries and decreasing number of women attempting vaginal birth after CS delivery. This retrospective study aimed to determine the outcome of VBAC among women in JOOTRH which will help in developing policies and guidelines for managing subsequent deliveries after one previous CS. The main objectives were to determine the indications of the previous CS, prevalence of VBAC, number of successful VBAC and evaluate the complications associated with VBAC among women in JOOTRH. The study was done at the maternity ward in JOOTRH where a review of 187 files was done, spreading out from the year 2022 to March 2024. Abstraction of data from patients’ records was done and the data analyzed using SPSS software. The results were presented in frequencies and percentages. Formal approval from Ethics and Research Committee in Uzima University was obtained and permission to collect data was obtained from the hospital administration. Confidentiality was ensured by not disclosing names or in-patient numbers of the patients. The results of the study show that there is an increasing trend in the number of attempted VBAC per year. The highest number of deliveries occurred in the year 2023(January-August), with 92 deliveries, accounting for 49.2% of the total. This is due to improved patient monitoring on admission and an increased number of patients admitted in 2023.The year with the lowest number of deliveries was 2020, with 27 deliveries, making up 14.4% of the total. This is majorly attributed to reduced admissions due to the COVID-19 pandemic and reduced staff number due to the age restriction in accordance with the COVID-19 guidelines The results also showed that poor uterine contractions was the leading indication for previous cesarean deliveries with 55 (29.4%) cases. The number of successful VBAC was 31 cases which accounts for 16.6 % of the total. The number of failed VBAC that resulted in CS deliveries was 156 cases that is, 83.4% of the total attempted VBAC deliveries. The most prevalent complication was postpartum hemorrhage with 15 cases accounting for 8%. The study concluded that the success rate of VBAC was low, therefore, there is need to emphasize those factors that lead to a higher likelihood of success. The study recommends proper documentation of patients’ details be done, encouragement of counseling to those who meet the criteria for VBAC and more research be done on the factors contributing to the failure of VBAC.