Abstract
Objective: to compare the vaginal birth rates 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.
Funding: there is no funding involved in this work.
Keywords: Vaginal birth after caesarean, induced labour, expectant
management, repeat caesarean, trial of labour after caesarean.
Clinical Trial Registration : Prospective registration was done
with the Clinical Trial Registry of India (number-CTRI/2018/09/015719)