A G4P3 woman requests trial of labour after one prior lower segment cesarean section. Her prior indication was breech presentation and she has no other comorbidities. Which single factor in her history most strongly predicts a successful vaginal birth after cesarean?

• A A previous vaginal delivery ✓
• B Birth weight of the current fetus below 3500 g
• C Maternal age below 35 years
• D An interdelivery interval longer than 18 months

Explanation

Across large cohorts, a previous vaginal delivery, whether before or after the cesarean, is the single strongest predictor of successful TOLAC, raising success rates to well over 80 percent. Interdelivery interval, fetal weight, and maternal age modify success modestly but none approaches the predictive power of a prior vaginal birth. Indication of breech is itself favourable but less decisive than prior vaginal birth.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.