title: [Predictors of birth outcomes related to women with a previous caesarean section: experience of a Motherhood Center, Bizerte].
abstract: BACKGROUND
  Caesarean section (CS) rates have been significantly increasing in recent decades. For this reason, the obstetrician must frequently decide on the most appropriate mode of delivery for mother and fetus. This study aims to describe vaginal birth after previous cesarean section (VBACs) in our obstetric practice and to identify factors significantly associated with failed VBACs.
  
  
  METHODS
  We conducted a population-based study among women with a history of previous cesarean delivery. The study design was retrospective, longitudinal, descriptive and analytical. The case study was conducted over a two years and three months period, from January 1, 2012 to March 31, 2014 during which we collected data from 423 medical records of patients attempting VBACs at the Maternity and Neonatology Center, Bizerte.
  
  
  RESULTS
  The rate of attempted VBACs was 47%. The success and the failure rates of these attempts were 82,7% and 17,3% respectively. The main factors for a poor prognosis in patients attempting VBACs were: the absence of a previous vaginal delivery (p = 0.005), a previous indication for cesarean section due to stagnation of dilatation or poor labor progress, (p 0.049 and 0.002 respectively), gestational age at delivery of = 40 weeks (p = 0.046), parity <3 (p = 0,75.10-4), Bishop score <6 at the onset of labor (p = 0,23.10-47), "active labor" duration = 6h (p = 0.002), length of labor> 8 h (p = 0.0031) and the occurrence of abnormal fetal heart rate (FHR) during labor (p = 0144.10 -9). We observed seven cases of uterine rupture (1.7%). There were no cases of maternal mortality. Total maternal morbidity rate was 9,5%. The difference in rates of maternal complications between the two groups (failed and successful attempted vaginal birth after cesarean) was not statistically significant.
  
  
  CONCLUSIONS
  Attempting vaginal birth after cesarean on the basis of good and poor prognostic factors and patient consent, contributes to the reduction in maternal and neonatal morbidity and should lead to the establishment of clear and codified Tunisian guidelines as part of a policy against unjustified iterative caesarean sections.
authors.affiliation: Université El Manar2, Tunis, Tunisie; Faculté de Médecine de Tunis, Tunisie; Service de Gynécologie et Obstétrique, CHU Bougatfa, Bizerte, Tunisie.
authors.forename: Amira
authors.initials: A
authors.lastname: Ayachi
authors.affiliation: Service de Gynécologie et Obstétrique, CHU Bougatfa, Bizerte, Tunisie.
authors.forename: Sadok
authors.initials: S
authors.lastname: Derouich
authors.affiliation: Service de Gynécologie et Obstétrique, CHU Bougatfa, Bizerte, Tunisie.
authors.forename: Insaf
authors.initials: I
authors.lastname: Morjene
authors.affiliation: Université El Manar2, Tunis, Tunisie; Faculté de Médecine de Tunis, Tunisie; Service de Gynécologie et Obstétrique, CHU Bougatfa, Bizerte, Tunisie.
authors.forename: Lassaad
authors.initials: L
authors.lastname: Mkaouer
authors.affiliation: Service de Gynécologie et Obstétrique, CHU Bougatfa, Bizerte, Tunisie.
authors.forename: Dalila
authors.initials: D
authors.lastname: Mnaser
authors.affiliation: Université El Manar2, Tunis, Tunisie; Faculté de Médecine de Tunis, Tunisie; Service de Gynécologie et Obstétrique, CHU Bougatfa, Bizerte, Tunisie.
authors.forename: Mechaal
authors.initials: M
authors.lastname: Mourali
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006340:Heart Rate, Fetal / Q000502:physiology; D006801:Humans; D007743:Labor, Obstetric; D008137:Longitudinal Studies; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014416:Tunisia; D014597:Uterine Rupture / Q000453:epidemiology; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Trial of labor; cesarean section; previous cesarean section; scarred uterus; vaginal birth after cesarean section