Materials and methods
Women with previous caesarean deliveries visiting the hospital during
their antenatal period were screened in their third trimester, and a
well-informed consent was taken from those who fulfilled the inclusion
criteria of the study. A detailed history was taken,
and maternal characteristics ( age, parity,BMI, any prior vaginal delivery or prior
VBAC, indication of the previous CS, birth weight of the
previous babies, and inter-delivery interval) were noted. Previous
operative records were checked for the type of caesarean, gestational
age, place of previous CS, type of closure, and for any related
intraoperative or postoperative complications. On admission of the woman
for delivery, the estimated gestational age, presence or absence of
preeclampsia (PE), and gestational diabetes mellitus (GDM) were checked
and recorded. Cervical examination findings were noted, and a decision
for or against the need for an IOL was made. Women who needed IOL, were
induced by intracervical insertion of an 18F Foley’s catheter under all
aseptic precautions with the use of well-prepared and autoclaved Foley’s
insertion sets. Women with a higher Bishop’s score were induced with
oxytocin alone.
Maternal outcomes were assessed in the form of VBAC rate, CS rate,
indication of repeat CS, methods of IOL used, rate of change of Bishop’s
score at the end of cervical ripening, IDI (induction-delivery
interval), reasons for TOLAC failure, rate of scar dehiscence or
rupture, PPH (postpartum haemorrhage), need for blood transfusion, and
any other maternal morbidity. Neonatal outcomes were assessed in the
form of birthweight, 1 minute and 5 minute APGAR scores, the requirement
of ventilation, admission to the NICU, or any other neonatal morbidity
(minor or major) during the hospital stay. Enrolment and analysis of the
study is explained in figure 1.