( BJOG . 2024;131:1771–1779. DOI: 10.1111/1471-0528.17872) The increasing global rate of cesarean deliveries (CDs) has led to concerns about associated complications and vaginal birth after cesarean (VBAC) has gained popularity to limit the surgical implications of repeat CD. When attempting VBAC, uterine rupture is a concern due to altered uterine scar tissue that develops at the previous hysterotomy site. Patients in low-income and middle-income countries may be recommended for repeat CD due to limited resources and an inability to properly care for a patient who develops uterine rupture as it is associated with increased maternal and neonatal morbidity and mortality. Identifying patients at increased risk of uterine rupture is paramount when considering VBAC in these settings. This study aimed to evaluate the accuracy of the sonographic lower uterine segment (LUS) thickness in comparison to thickness found at laparotomy and in predicting successful VBAC in a resource-limited setting. Conducted as a prospective study in a tertiary hospital in Ghana between November 2021 and November 2022, it involved 311 women with a singleton pregnancy and previous CD who either opted for a trial of labor after cesarean (TOLAC) or underwent an elective repeat CD. 2D transvaginal ultrasound (TVUS) was used to measure LUS thickness, and these findings were compared with intraoperative measurements taken during CD. Obstetrician/surgeon were blinded to LUS findings.