Vaginal birth after cesarean delivery in the West African setting.

OBJECTIVE: To determine the fetal weight beyond which women with one previous cesarean delivery (CD) are most likely to have a repeat CD. METHODS: A retrospective cohort study of 586 women who had one previous CD and were undergoing trial of labor was conducted in Accra, Ghana. Following delivery, the women were allocated to one of three groups according to whether they had a successful vaginal delivery, underwent a CD for cephalopelvic disproportion, or underwent a CD for another indication. The groups were then compared using analysis of variance or Kruskal-Wallis tests. Multiple logistic regression was used to assess the effect of fetal weight on the odds of having a repeat CD. RESULTS: A fetal weight greater than 3.45 kg tripled the odds of having a repeat CD, and the probability of having a repeat CD were 50% for a fetal weight of 3.70 kg. CONCLUSION: In settings similar to those in Ghana, women who have undergone a previous CD whose fetuses weigh more than 3.70 kg are likely to have less than a 50% chance of having a successful vaginal delivery.