Stage of labor at admission among Ugandan women with a prior cesarean, and its impact on management and delivery outcomes.

<bold>Objective: </bold>To describe stage of labor at admission among women with a prior cesarean, and examine its impact on intrapartum management and delivery mode.<bold>Methods: </bold>In a prospective cohort study, women admitted to Mbarara Regional Referral Hospital, Uganda, for delivery were enrolled between March and June 2015. Rates of vaginal delivery (VBAC) and in-hospital trial of labor (TOL) were compared between early (<4 cm dilation) and late (≥4 cm) presenters. Women were interviewed after delivery about decision making and labor preferences.<bold>Results: </bold>Overall, 188 women comprised the study sample; 98 (52.1%) and 65 (34.6%) women presented at ≥4 cm and ≥6 cm, respectively, and 18 (9.6%) were fully dilated. In-hospital TOL and VBAC rates were 25.5% (42/165) and 9.6% (18/188), respectively. Compared with early presenters, late presenters were significantly more likely to undergo TOL (28/88 [31.8%] vs 14/77 [18.2%]; odds ratio [OR] 2.3, 95% confidence interval [CI] 1.1-5.0), and achieve VBAC (16/98 [16.3%] vs 2/90 [2.2%]; OR 7.6, 95% CI 1.7-35.1).<bold>Conclusion: </bold>Most women arrived in active labor, but most had a repeat cesarean. Work is needed to understand the clinical decision making and provider management driving low TOL and VBAC rates. [ABSTRACT FROM AUTHOR]