SUCCESSFUL VAGINAL BIRTH AFTER CESAREAN ACROSS MATERNAL AGE GROUPS: A 9-YEAR SINGLE-CENTER CASE SERIES
SUCCESSFUL VAGINAL BIRTH AFTER CESAREAN ACROSS MATERNAL AGE GROUPS: A 9-YEAR SINGLE-CENTER CASE SERIES

Summary/Abstract: Cesarean section as method for delivery is increasingly performed worldwide. As a result, more and more pregnant women with previous uterine scar are potential candidates for trial of vaginal labor in subsequent pregnancies. Vaginal birth after cesarean section has a number of advantages for the mother and newborn, but at the same time it carries a certain risk of uterine rupture. Advanced maternal age is often associated with lower success rates of VBAC, but its role as an independent predictor of adverse outcomes, such as uterine rupture or stillbirth, remains unclear. Objective: The aim of this study was to determine the age distribution of women undergoing vaginal delivery after cesarean section and the influence of age on the success of TOLAC, the risk of uterine rupture and the likelihood of stillbirth. Materials and methods: This study included successful VBAC cases between 2017 and 2025 in a maternity clinic at the University Hospital "Maichin Dom", Sofia. Patients were categorized into four age groups: <30, 30–34, 35–39, and ≥40 years. Cases of intrauterine fetal demise were classified as antepartum events when diagnosed prior to the onset of labor. Intrapartum fetal deaths were recorded separately. Uterine rupture cases were included if associated with uterine contractions. Results: The largest proportion of patients was observed in the 30–34 age group, followed by the 35–39 age group. Advanced maternal age (≥40 years) represented a substantial subgroup within the cohort. The highest proportion of successful VBAC was observed in women aged 30–34 years (34.1%), followed by those aged 35–39 years (30.2%). Women aged ≥40 years accounted for 14.8% of all successful VBAC cases. No cases of intrapartum fetal death were observed in the cohort. The distribution of antepartum intrauterine fetal demise was similar across maternal age groups. The overall proportion of uterine rupture among women presenting in labor was 4.7%. Rupture cases were distributed across multiple age groups, with the highest proportion observed in women aged 35–39 years (6.8%), followed by <30 years (5.0%) and 30–34 years (4.6%). No rupture cases were observed in women aged ≥40 years Conclusion: Maternal age alone is not an independent predictor of VBAC success, uterine rupture, or stillbirth in women undergoing TOLAC

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