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.