Flamm and Geiger scoring system: Prediction of successful vaginal birth after Caesarean section (VBAC)

Abstract

Background: Vaginal birth after caesarean section (VBAC) offers numerous maternal and neonatal benefits when appropriately selected. Predicting the success of VBAC is essential to reduce maternal morbidity and optimize delivery outcomes. The Flamm and Geiger scoring system is a validated tool to assess the likelihood of successful VBAC based on clinical parameters.

Objective: To evaluate the predictive value of the Flamm and Geiger scoring system for successful VBAC among a prior cesarean delivery case in a private hospital setting in Bangladesh.

Methods: A prospective observational study was carried out on 60 pregnant women who intended to have a trial for vaginal delivery after previous one caesarean section. The study was carried out in the department of obs and gynae of a private hospital over a period of one year.

Result: In the present study, out of 40 patients, 45% had successful VBAC and 55% had to undergo emergency LSCS. Among successful VBAC cases, 83.3% patients had spontaneous vaginal delivery while 16.7% had vacuum assisted. No cases of forceps-assisted delivery were recorded. Most of the patients with total Flamm and Geiger score < 3 at the time of admission had emergency caesarean section while most of the patients with score > 4 had successful VBAC.

Conclusion: The Flamm and Geiger scoring system proved to be a reliable predictor of VBAC success, with scores ≥5 significantly associated with favorable outcomes. Prior vaginal delivery, non-recurrent CS indications, and favorable cervical conditions at admission also enhanced success rates. This tool can support individualized counseling and reduce unnecessary repeat Caesareans, especially in low-resource settings. Its integration into routine practice may improve maternal outcomes and promote safer trial of labor after Caesarean.

EWMCJ Vol. 14, No. 2, July 2026: 208-214