Introduction
Due to the rampantly rising caesarean section rates worldwide, a large number of women have a scarred uterus which makes the choice of mode of delivery in subsequent pregnancies very difficult and challenging for them owing to the numerous risks associated with both CS and TOLAC following a previous caesarean section.1
Although TOLAC is urged as a reasonable option for these women, its rates largely vary amongst various countries and institutions owing to the diverse population demographics and prevailing hospital protocols.2 The proportion of women undergoing TOLAC has been on the decline, fuelled by reports of negative outcomes like ruptured uteruses and hypoxic ischemic encephalopathy in the neonate3, and additionally due to the rigorous international criteria pertaining to the needed hospital facilities for pursuing a TOLAC.4 The data from previous studies shows 60–80% TOLAC culminating in a successful vaginal birth.5,6
Ethnicity, age, BMI of the mother, history of a vaginal birth, birthweight of the previous baby, indication of previous caesarean, preeclampsia, the bishop’s score at admission, and the need for labour induction are among the many studied factors that aid in the success prediction of TOLAC. 7
One-fourth of the women undergoing TOLAC need IOL.8When labour onset is spontaneous, proceeding with TOLAC is easier than in induced labor, as the risk of uterine rupture is high when prostaglandins and oxytocin are used. 1 However, Foley’s catheter, being a mechanical method of cervical ripening, and the IOL do not bear this disadvantage.
The purpose of this study was to determine the VBAC success rate and the factors that influence it in an Indian cohort while simultaneously assessing maternal and neonatal outcomes following TOLAC. There have been very few studies on the success of IOL in Indian women following caesarean section. In our study, the success rate of IOL in TOLAC was also evaluated.