Tweetable abstract
Induction of labour at 40 weeks results in significantly higher VBAC rates compared to expectant management
Title: 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.
Introduction :
The optimal timing of delivery for women with a previous caesarean section without any maternal or foetal complications is not well studied. Trial of Labour After Caesarean section (TOLAC) has been well accepted for all eligible cases and guidelines have been laid for eligibility for TOLAC.1,2,3 RCOG recommends 41 weeks for termination of these eligible patients if they do not go into spontaneous labour by the expected date of delivery.4Spontaneous labour is always considered safer and has a higher chance of successful vaginal birth after caesarean (VBAC) than induced labour in a woman with a previous caesarean section. Studies have shown that there is a one and a half times higher risk of caesarean section and a two to three times higher risk of rupture uterus with the induction of labour compared to spontaneous labour.4,5,6 Awaiting beyond 40 weeks is with the hope that they will achieve spontaneous labour. However, past dates have their problems.7,8 like a passage of meconium and reduction in amniotic fluid. Recently published meta analysis9 also concluded that there is an increased risk of stillbirth after 40 weeks. The largest retrospective study on women with previous caesarean delivery has shown that induction of labour at 39 weeks was found to have lower odds of caesarean section compared to those managed expectantly.10 Successful and safe vaginal births will be an asset in limiting the escalation in repeat caesarean section rates. There are no randomized controlled trials available to compare expectant management till 41 weeks and induction at 40 weeks among women with uncomplicated pregnancy with a previous one caesarean section. Expectant management and not spontaneous labour is a true comparator for elective induction of labour at term. Hence this randomized controlled trial was undertaken with the primary objective to compare the successful vaginal birth rates in women with previous one lower segment caesarean section when induced at 40 weeks compared to expectant management till 41 weeks.