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.