VBAC In Women Undergoing IOL With Dinoprostone Versus Spontaneous Labor

OBJECTIVE: To compare the rate of vaginal birth in women attempting vaginal birth after caesarean delivery (VBAC) through labour induction with dinoprostone versus a trial of spontaneous labour. METHODS: A 10-year retrospective cohort study in a tertiary care hospital of women with one prior caesarean delivery. Women who attempted VBAC with labour induction with dinoprostone were compared with women undergoing spontaneous labour. Logistic regression analyses were performed to assess the relationship between VBAC success and labour induction taking into account confounding variables. Both maternal and neonatal safety were studied to find a difference between the group with spontaneous labour versus the group labour induction. RESULTS: A total of 1076 women in the cohort attempted VBAC (649 with spontaneous labour and 427 with induced labour). Women who were given a trial of spontaneous labour were more likely to have a successful VBAC (70.3% compared with 48.7%, odds ratio (OR) 2.49, 95% confidence interval (CI) 1.93–3.21). If women have had a previous vaginal delivery they were more likely to have a successful VBAC, OR of 2.98, 95% CI 2.08-4.27. The risk of uterine rupture (0.5% for induced labour compared with 0.6% for spontaneous labour) or overall morbidity (2.7% compared with 2.1%) was not significantly increased in the women with labour induction. CONCLUSION: Women with a previous caesarean section have a lower VBAC rate with labour induction versus spontaneous labour. If they have a previous vaginal delivery, the chance of a vaginal delivery increases. Overall, vaginal birth is safe and effective in women with one caesarean section with labour induction with dinoprostone.