Results
The study enrolled 124 women (figure 1) who met inclusion criteria and underwent TOLAC, of whom 54.8% had VBAC and 45.2% had repeat CS. The IOL rate in the study was 69.4%, with only 30.6% of women experiencing spontaneous labor.
The baseline characteristics of the VBAC and CS groups are summarised in Table 1. There was no significant difference between the mean age, gravidity, mean gestational age at delivery, and EFW among women who had VBAC and CS following TOL. The mean height, weight, and BMI were also similar and did not affect TOLAC success. Foetal distress (25.8%) was the most common indication of previous CS in the enrolled women. Indication of the previous CS, inter-delivery interval, birthweight of the previous child, or history of prior VBAC or vaginal delivery did not influence the TOLAC outcome in our study.
When compared to women who had IOL, the VBAC rate was significantly higher in women who had spontaneous onset labour (84.2% vs. 52%). Women who had successful VBAC had significantly higher mean cervical dilatation (2.21 cm vs. 1.53 cm), mean cervical effacement (29.4% vs. 20.3%), and mean Bishop’s score at admission (5.12 vs. 3.66) than those who had repeat CS.
Most of the women were induced between 37 and 38 weeks. Preeclampsia (16.9%), IUGR (14.9%), and ICP (12.9%) were the leading indications of IOL. Only for ICP, the VBAC rate was much lower than the CS rate (18.7% vs. 81.3%).
IOL was done in 35.5% of women using Foley’s catheter plus oxytocin and in 33.9% of women using oxytocin alone. VBAC and CS rates were similar (50% each) in the oxytocin group, but the CS rate was significantly higher (65.9% vs. 34.1%) in the Foley plus oxytocin group.
The mean induction-delivery interval (IDI) for women who were induced with two IOL agents was significantly longer than that for those who were induced with a single IOL agent (17.46 vs. 8.7 hours) (p  0.001). Table 1 summarises the IOL-related findings in both groups.
The rate of operative vaginal delivery in the present study was 8.1%. The majority of the women (21.8%) had an emergency repeat CS due to pathological Cardiotocography (CTG). Figure 2 depicts the various indications for repeat CS in our study and the intraoperative findings observed. Out of the six caesareans done for suspicion of scar dehiscence, scar dehiscence was present in only one case intraoperatively (16.6%). None of the women had a uterine rupture. The rate of scar dehiscence was 4% (5 out of 124).
Complications occurred in approximately 27.4% of women, with rates similar in the VBAC and CS groups, with 8% having atonic PPH, 5.6% receiving blood transfusions, and 4% having a cervical tear. The mean birthweight was similar in neonates born to women who had VBAC and CS (2.78 vs. 2.66 kg). Around 24.1% of neonates were LBW. A significantly higher number of LBW neonates were born by CS (63.4%) compared to VBAC (36.6%). The complication rate was significantly higher in neonates born by CS (51.7% vs. 30.8%) with higher incidences of LBW and TTNB. The majority of the neonates in the study did not have birth asphyxia, nor did they require mechanical ventilation or NICU transfer. Only one neonatal death was reported in the study.
The contraception acceptance rate was 29.8% in our study, and it was significantly higher in women who had CS compared to those who had VBAC (41% vs. 20.5%). Table 2 and 3 summarises the maternal and neonatal complications observed during the study.