TRIAL OF LABOR AFTER ONE PREVIOUS LOWER UTERINE SEGMENT TRANSVERSE CESAREAN SECTION: SUCCESS RATE AND ASSOCIATED FACTOR AT WOLLEGA UNIVERSITY COMPREHENSIVE SPECIALIZED HOSPITAL- CROSS-SECTIONAL STUDY

ABSTRACT Background: Trial of labor after cesarean offers an opportunity for vaginal birth after cesarean, reducing the risks associated with multiple repeat cesareans. Although trial of labor after cesarean section is endorsed by international guidelines, its utilization and success rates vary widely across settings, particularly in low-resource regions like Ethiopia. Limited prospective data exist in western Ethiopia regarding the success rate of trial of labor after cesarean section and its associated factors. Objectives: This study aimed to assess success rate of trial of labor and associated factors among women with one previous lower uterine segment transverse cesarean section at Wollega University comprehensive specialized hospital. Method: Hospital-based cross-sectional study was conducted at Wollega University comprehensive specialized hospital from September 1, 2025 to March 2026 G.C. 141 eligible women for trial of labor were recruited using consecutive sampling (non-probability) at admission. Data was collected prospectively through structured questionnaire. Epidata Version 4.6 was used to enter data and SPSS version 27.0.1 for analysis. Bivariate and multivariable logistic regression analysis was carried out. Statistical significance was determined based on the odds ratio with its 95% confidence interval and a p-value of <0.05. Results: During the 7-month study period, of the 141 women who underwent TOLAC, 56 (39.7%; 95% CI: 31.7–47.7%) achieved successful VBAC. Of the 85 women (60.3%) who required emergency cesarean delivery, the most common indication was abnormal labor progress, accounting for 53.5% (46 out of 85).Cervical dilatation ≥4cm at admission was found to be associated with successful TOLAC (AOR = 7.15, 95% CI: 1.95–26.20, p < 0.001) increasing success rate by 7-fold,having vaginal delivery before the previous cesarean section increases the chance of  successful TOLAC by 5.4 fold (AOR = 5.40, 95% CI: 1.39–21.02, p = 0.015) compared to those who has no prior vaginal delivery. Conclusion VBAC success rate was lower than international and national benchmarks. Cervical dilatation at admission and having prior vaginal delivery before cs were strong independent predictors. These predictors should guide TOLAC counseling and candidate selection in similar low-resource settings. Key words: Trial of labor after cesarean, VBAC, Success rate, associated factors, Wollega University, Prospective cross- sectional study, Ethiopia