Publication:

Prospective study on success rate and outcomes of trial of labour after caesarean at a tertiary hospital

Background The increasing prevalence of pregnancies with a scarred uterus has led to a rise in repeat caesarean sections (CS), which are associated with significant maternal morbidity. Trial of labour after caesarean (TOLAC) offers an alternative to reduce CS rates and associated complications. This study aimed to determine the success rate of TOLAC and evaluate maternal and fetal outcomes in a tertiary care hospital.

Methods This prospective observational study was conducted over one year (April 2023 to February 2024) at Fernandez Hospital  a tertiary maternity centre. A total of 206 women with singleton term pregnancies and one previous lower segment caesarean section (LSCS), eligible and consenting for TOLAC, were included. Women with contraindications to vaginal birth or significant comorbidities were excluded. Maternal and neonatal outcomes were recorded and analyzed using appropriate statistical tests, with p<0.05 considered significant.

Results The success rate of TOLAC was 21.8% (45/206). Factors significantly associated with successful vaginal birth after caesarean (VBAC) included younger maternal age (p=0.019), shorter inter-delivery interval (p=0.048), previous VBAC (p<0.001) and spontaneous onset of labour (p=0.001). Induced labour was associated with higher CS rates. Postpartum haemorrhage (PPH) was significantly higher in the VBAC group (20% vs 6.2%, p=0.009). There were no cases of maternal mortality or major surgical injuries. Neonatal outcomes, including NICU admission and morbidity, were comparable between groups, with no neonatal deaths reported. Cord arterial pH was slightly lower in the VBAC group (p=0.023), though clinically acceptable.

Conclusions The success rate of TOLAC in this study was relatively low, likely due to high induction rates. However, with careful selection and monitoring, TOLAC remains a safe option without significant adverse maternal or neonatal outcomes. Reducing unnecessary inductions and primary caesarean sections may improve VBAC success rates.