The outcomes of trial of labour after cesarean section following induction of labour compared to spontaneous labour
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- Al-Shaikh, G. & Al-Mandeel, H. Arch Gynecol Obstet (2013) 287: 1099. doi:10.1007/s00404-013-2709-z
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To determine the success rate of vaginal birth after cesarean birth (VBAC) and its outcome when labour was induced compared to spontaneous labour.
Prospective cohort study of all women who had lower segment caesarian section (LSCS) in any previous delivery and were admitted for a trial of labour after cesarean between April 2010 and March 2011 at a University Hospital. We compared the success rates of VBAC in women who had induction of labour (IOL) to those who came with spontaneous labour.
During the study period, 320 women who elected to have trial of labour after cesarean and were included in the study, 268 (83.8 %) had spontaneous labour and 52 (16.3 %) had IOL. The most common indications for IOL were post term pregnancy 30 %, diabetes during pregnancy 19 % and prelabour spontaneous rupture of membranes 17 %. There was no difference between both groups in age, previous vaginal delivery and gestational age. In terms of the method of induction, the most commonly used method was transcervical Foley catheter in 21 cases (40.4 %) and then Oxytocin in 19 cases (36.5 %), nine women had combined methods of induction (17.3 %). Prostaglandin E2 was used in three women (5.8 %). The incidence of successful VBAC in spontaneous labour was 72 %, however, when induced, the incidence of successful VBAC was 63.5 %. Compared to the spontaneous labour group, induced women had significantly higher rate of CS (36.5 vs. 28 %; P = 0.026).
Women with one previous CS who undergo IOL have lower success rates of vaginal delivery compared to those presented in spontaneous labour. These findings might help clinicians and patients in the decision making for the method of delivery when it comes to pregnancy with a previous scar.