Trial of Labour After Caesarean Section (TOLAC), Pattern, Outcome and Contemporary Predictors in A Tertiary-Level Obstetric Population in Southwest Nigeria: A Retrospective Descriptive Analysis
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Abstract
Background: The rising rate of caesarean section (CS) globally has led to an increasing population of women with uterine scars, necessitating evaluation of safe delivery options in subsequent pregnancies. Trial of labour after caesarean (TOLAC) offers an opportunity to achieve vaginal birth after caesarean (VBAC). However, its success and safety depend on careful patient selection and clinical factors. This study evaluated the pattern, outcomes, and predictors of TOLAC in a tertiary health facility.
Methods: This retrospective descriptive study was conducted at Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Ogbomoso, reviewing records of 292 women who underwent TOLAC between January 2020 and January 2025. Data were extracted from case notes and hospital registers using a structured tool. Descriptive statistics summarized variables, while chi-square tests assessed associations. Logistic regression identified independent predictors of VBAC success. Statistical significance was set at p<0.05.
Results: The VBAC success rate was 67.8%, while 32.2% had failed TOLAC. Significant predictors of successful VBAC included previous vaginal delivery (AOR=3.21), prior VBAC (AOR=4.05), Bishop score ≥6 (AOR=3.58), spontaneous labour (AOR=2.76), and booked pregnancy (AOR=2.14) (p<0.05). Maternal complications were relatively low. Neonatal outcomes were largely favourable, though 19.2% required Neonatal Intensive Care Unit (NICU) admission.
Conclusion: TOLAC demonstrated a high success rate with acceptable maternal and neonatal outcomes. Promoting carefully selected TOLAC, alongside adequate antenatal care and intrapartum monitoring, can reduce repeat caesarean sections and improve overall obstetric outcomes in similar settings.
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