Title : Comparison of pregnancy outcomes after repeat cesarean delivery versus trial of labor following a single lower uterine segment cesarean section at term in three teaching hospitals in Addis Ababa, Ethiopia: A prospective cohort study
Abstract:
The global rise in cesarean section rates has prompted a growing interest in evaluating the safety and outcomes of trial of labor after cesarean (TOLAC) compared to elective repeat cesarean delivery (ERCD). Despite international guidelines supporting TOLAC in selected cases, uncertainty remains regarding associated risks in low-resource settings.
This prospective cohort study assessed maternal and perinatal outcomes among women with a single previous lower uterine segment cesarean section who either underwent TOLAC or ERCD in three teaching hospitals in Addis Ababa, Ethiopia. A total of 406 women were enrolled: 200 underwent TOLAC and 206 had ERCD. The rate of neonatal ICU admission was significantly higher in the TOLAC group (19.5%) compared to the ERCD group (2.4%) (OR 9.7; 95% CI: 3.07–19.78), primarily due to perinatal asphyxia. Additionally, postpartum complications were more frequent in the TOLAC group (10%) versus the ERCD group (1%) (OR 11.3; 95% CI: 2.3–42.78).
These findings highlight increased risks associated with TOLAC in our setting, potentially reflecting the quality of intrapartum care. Nevertheless, TOLAC remains a safe and viable option in carefully selected women when appropriate monitoring and timely intervention are ensured.
