Second pregnancy vaginal birth after cesarean- impact of maternal age on outcomes from a retrospective cohort study

The rate of cesarean delivery (CD) in Qatar is rising at an alarming rate. Vaginal birth after cesarean section (VBAC) is associated with lower maternal morbidity and is an important option for younger mothers. This study compared the pregnancy outcomes of second pregnancies in women with prior CD, according to their age groups, with the aim of individualising VBAC counselling.

This retrospective study divided women in their second pregnancies based on age: young group (YG<25 years), control group (CG, 25-35 years), and advanced age group (AG>35 years). The primary outcome was the mode of delivery.

Out of 2,729 women, 18.2 % had a VBAC (27.4 % in YG vs. 9.5 % in AG). Nearly 48 % agreed to a TOLAC (57.9 % in YG and 41.8 % in AG), 38 % of whom had a successful VBAC. Among those who opted for TOLAC, 47.3 % in YG had a successful VBAC, compared to only 22.8 % in AG (p<0.001). While hypertension, diabetes, macrosomia and preterm birth reduced VBAC, postdated and uncomplicated pregnancies increased the rates. Compared to CG, YG had 35 % lower odds of repeat CD (aOR=0.64, CI=0.49-0.85, p=0.002), while AG had nearly two times higher odds (CI=1.26-2.95, p=0.003), after adjusting for confounders.

Maternal age emerged as an important predictor of repeat cesarean, with younger mothers having a much higher chance of successful VBAC. More than half with uncomplicated pregnancies opted for an elective CD, highlighting the requirement for improving counselling services that motivate women to take up VBAC and improve their confidence in the healthcare system.