Year: 2025
Type: preprint
Abstract: Objective: To identify factors associated with the preferred mode of delivery among women with a prior vaginal birth after caesarean section (VBAC). Design: Secondary analysis of a multicentre observational cohort. Setting : Two tertiary care centres in the Czech Republic Population : Women who had a term VBAC as their second delivery Methods: Participants completed validated questionnaires PFDI-20, PISQ-IR, and ICIQ-SF and underwent 4D transperineal ultrasound to assess levator ani muscle avulsion. Preferred mode of delivery under full autonomy was recorded. Statistical tests were used to identify independent predictors of a preference for caesarean birth. Main Outcome Measures: Self-reported preferred mode of delivery (vaginal vs caesarean). Results: Of 164 women, 64.2% preferred vaginal delivery, 13.9% preferred caesarean, and 21.8% were undecided. On multivariable analysis, obstetric anal sphincter injury (OASI) (OR 8.38, 95% CI 1.20-58.30; p=.031) and episiotomy (OR 3.07, 95% CI 0.98-9.59; p=.047) were associated with a preference for caesarean delivery. Postpartum sexual inactivity was associated with caesarean preference in univariable analyses but was not an independent predictor after adjustment. Conclusions: Most women with prior VBAC preferred future vaginal birth; however, previous perineal trauma, particularly OASI and episiotomy, was associated with a preference for caesarean delivery. These findings support trauma-informed counselling that addresses pelvic floor outcomes and sexual health in shared decision-making.
Authors: Jan Dvorak, Tomas Fucik, Jaromir Masata, Zdenek Rusavy, Michal Kozerovsky, Marian Rybar, Kamil Svabik
Institutions: Charles University, Czech Technical University in Prague
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Award: G5985678231
OpenAlex ID: W7084095738
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