Spontaneous Versus Medical Induction of Labour in Previous One Caesarean Term Patients: A Prospective Analytical Study

Abstract

Introduction: The rate of Caesarean Section (CS) either primary or repeat has significantly increased worldwide over the time. Trial of Labour After Caesarean (TOLAC) is an important strategy to limit the number of repeat CS. TOLAC either spontaneous or induced offers both benefits and risks to the mother and neonate. Aim: To determine the risks and benefits of inducing labour with Prostaglandin Gel (PGE2) in women with previous one CS and to compare it with patients who developed spontaneous labour in terms of fetal and maternal outcome. Materials and Methods: A prospective interventional study was conducted over a period of one year from June 2017 to May 2018. A total of 322 pregnant patients with previous one CS who fulfill the eligibility criteria for TOLAC were enrolled and divided into two groups. Of these 74 patients were induced with PGE2 gel (study group) and 248 experienced spontaneous labour. Data were analysed via Chi-square test and unpaired t-test using analytical tool pack of Microsoft excel (version-10.0)-2010 home edition. Results: In study group and control group, 51 (68.9%) and 191 (77.01%) women respectively delivered vaginally either spontaneous or assisted, but the difference was not statistically significant. Two cases in the study group had laparotomy for uterine rupture with favourable feto-maternal outcome. Vaginal Birth After Caesarean (VBAC) rate was significantly more in women who had history of prior vaginal delivery (p=0.0024). TOLAC was successful in 242 women while CS was done in 80 women. Mean BMI in women with successful TOLAC was significantly lower than in women with unsuccessful TOLAC (23.42±2.07 versus 26.08±3.07, p=0.0001). With an inter-pregnancy interval of 25-36 months, 45.1% in study group and 47.6% in control group delivered vaginally. Conclusion: For women with previous one CS, TOLAC is a reasonable option as compared to planned repeat Caesarean. In these women with continuous supervision, PGE2 is as safe and effective as spontaneous labour in achieving vaginal birth after Caesarean.