Comparison of Expectant Management Versus Induction of Labour at 40
Weeks on Successful Vaginal Birth Rate in Women with a Previous
Caesarean Section: A Randomized Controlled Trial and A Pilot Study.
Abstract
Objective: to compare the vaginal birth rate in women with previous one
lower segment caesarean section when induced at 40 weeks compared to
expectant management till 41 weeks. Design: A randomized controlled
trial Setting: Department of Obstetrics and Gynaecology, JIPMER, a
tertiary care teaching institution in the south of India. Population or
Sample: Low-risk women with previous one single lower segment caesarean
section with a singleton foetus in vertex presentation and eligible for
a trial of labour (TOLAC) at 40 weeks gestation. Methods: Block
randomization to two groups of thirty each. The induction group was
induced at 40 weeks with low dose oxytocin infusion or ripening with a
single application of a single balloon Foley catheter followed by
oxytocin infusion 24 hours later. The expectant group was managed in the
hospital with maternal and foetal surveillance and induced at 41 weeks
if they had not delivered by then. Main Outcome Measures: Vaginal birth
after caesarean section (VBAC). Results: The demography and pregnancy
variables were comparable in the two groups. Twenty out of thirty women
(66.67%) had a successful vaginal birth after caesarean section in the
induction group compared to ten out of 30 (33.33%) in the expectant
group. This difference was significant (RR 2.0, 95% CI: 1.13-3.52;
P=0.016) Conclusions: Among low-risk women with previous one lower
segment caesarean section willing and eligible for TOLAC, the successful
VBAC rate is significantly higher among those induced at 40 weeks
compared to those managed expectantly till 41 weeks.