Trial of Labor After Cs Either by Induction of Labor by Prostaglandin Versus Spontaneous Onset of Labor; A Comparative Prospective Observational Trial

Introduction: Introduction: The increased rates of complications of repeated CS encourage obstetricians to go for Trial Of Labor After CS (TOLAC). Aim: to study maternal and fetal outcome after labor induction with dinoprostone (PGE2) in women with previous one CS in comparison to spontaneous onset of labor Design: A prospective cross-sectional comparative study was conducted over from June 2019 to December 2019 in 2 hospitals one in Egypt and another in Saudi Arabia .

Patients and methods:  A total of 96 patients fulfilling the inclusion criteria were divided into 2 groups: Group (I) 48 patients with history of one lower segment cesarean section (LCSC) with no labor pains where induction of labor was done by using vaginal dinoprostone gel (PGE2), Group (II) 48 patients with previous history of LSCS with spontaneous onset of labor during the same period. Patients with previous one CS who fulfilled the eligibility criteria for TOLAC were enrolled and divided into two groups. Group (I) was assigned to one hospital where induction was done and Group (II) was assigned to second hospital where patients came with spontaneous onset of labor. The outcomes of the study were: success rate of VBAC in both groups, rate of instrumental deliveries, maternal and fetal complications.

Results: The success rate of VBAC was 71.9% among all studied patients. The success rate of VBAC in group (I) was 68.8% while in group (II) was 75%. NO statistical significance difference between type of vaginal delivery among studied patients or indication of repeated cesarean section among 2 groups. Success rate increased in cases with previous VBAC, decreased gestational age and fetal weight. One case of rupture uterus occurred during the study with successful repair. Conclusion: Induction of labor in women with one previous CS is safe as trial of VBAC with spontaneous onset.