Repeat Caesarean section or induction of labour

Obstetricians frequently need to decide whether to induce a woman who has previously been delivered by Caesarean section (LSCS). There is very little evidence from randomised controlled trials to aid their decision making. Observational studies, with their inherent flaws, suggest a 3.6% maternal complication rate in women undergoing repeat elective LSCS, and approximately 66% vaginal delivery rate and 1% uterine rupture rate in women who were induced. There is little evidence to guide the choice of induction agent. Various factors have been suggested to predict a successful vaginal delivery, but a previous vaginal delivery appears to be strongly predictive of a good outcome. Alternative strategies, such as stretching and sweeping the membranes or awaiting spontaneous labour, may reduce the need for induction. If labour is induced in a woman with a scarred uterus we should ensure that the high risk situation is not compounded by poor care in labour.