الفهرس 
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Abstract
The caesarean section rate has increased markedly nowadays; so, evaluation of methods of delivery after one caesarean section is needed to assess safety for both mother and baby, and to reduce rate of caesarean deliveries.
Since 1980 vaginal birth after caesarean (VBAC) grew in popularity as appropriate method of delivery after routine caesarean section so the dictum of “once caesarean always caesarean” has changed due to availability of blood banking, antibiotics and the change in type of uterine incision from classical vertical one to transverse incision of lower segment.
This retrospective cross-sectional study was conducted at department of obstetrics and gynecology - Faculty of Medicine - Ain Shams University Maternity Hospital on all patients admitted between 2017 and 2019 for vaginal delivery after one caesarean section.
Total number of deliveries recorded in the study period between 2017 and 2019 was 28428 deliveries. Total vaginal deliveries represented 41.97%, total cesarean section represented 58.03% and total instrumental deliveries represented 0.36%.
Patients who underwent a trial of vaginal delivery after cesarean section were 264 of total deliveries and the trial rate was 0.93 %.
Women were enrolled and data was collected from the patient’s files. Factors contributing to successful VBAC were assessed.
Our study reported that the majority of patients who had successful VBAC were in the 25-29 years age group (95.79%). On the other hand, the majority of patients who required repeated CS seen in the eldest group “35-40” years at (40.9%).
Regarding cervical dilatation, our study reported that most of patients were in active labour with ≥ 4cm dilatation 221 patients, (83.7%). About (91.4%) of them underwent successful VBAC versus 8.5% failed, delivered by CS.
Regarding head station, about 57.6 % of the patients had fetal head station at zero. Out of them 91.45%, were likely to deliver vaginally meanwhile the higher head station -2 had less success rate 59%.
Our study reported that, the number of patients that underwent successful VBAC is 229 out of 264 which represents (86.7%). The remaining 35(13.26%) patients failed in the trial and had caesarean section. One case recorded by instrumental delivery in the trial (0.38%).
Regarding causes of failure of the trial were 37.14% fetal distress, 31.4% scar tenderness, 25.7% failure of progress and 5.7% was due to vaginal bleeding.
Regarding maternal complications, our study reported that the most prevalent complications were post-partum hemorrhage (1.5%), post-partum fever (1.1%), sphincter injury (0.76%), bladder injury (0.7%), rupture uterus and placental abruption represented 0.38% for each.
Of total study group (n=264), 95.8% healthy neonates delivered without morbidity or mortality. Only 4.1% admitted to NICU. Of those who were admitted 2.3% due to low Apgar score, 1.5% due to TTN.
In conclusion, VBAC is a safe procedure. Single cephalic baby with only one previous caesarean delivery, maternal age (25-29 years), cervical dilatation ≥ 4 cm and fetal head zero station, increase the success of VBAC. On the other hand, the cervical dilatation < 4cm, increased maternal age (35-40 years) and high fetal head station (-2) decrease the chance of VBAC success. The risk of maternal and neonatal complications is much less with the successful VBAC.