Clinical predictors of successful trial of labour after two or more previous caesarean sections: development of a structured selection protocol from a prospective observational study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20261610Keywords:
VBAC, TOLAC, Multiple caesarean sections, Scar thickness, Bishop score, PredictorsAbstract
Background: Trial of labour after caesarean (TOLAC) in women with two or more previous lower segment caesarean sections (LSCS) remains underutilized because of concerns regarding uterine rupture and adverse maternal outcomes. Identification of reliable predictors may improve patient selection and optimize vaginal birth after caesarean (VBAC) success rates.
Methods: This prospective observational study was conducted over 18 months at a tertiary care teaching hospital in Maharashtra, India. A total of 113 women with ≥2 previous LSCS were included. Predictor variables including scar thickness, Bishop score, gestational age, maternal age, body mass index (BMI), previous vaginal delivery, neonatal birth weight and onset of labour were analysed using chi-square test followed by multivariable logistic regression.
Results: Among 113 women, 80 (70.80%) underwent TOLAC, of whom 65 (81.25%) achieved successful VBAC. Scar thickness >3 mm (p<0.001), Bishop score >6 (p<0.001), previous vaginal delivery (p<0.01), gestational age 37–40 weeks (p<0.001), BMI <30 kg/m² (p<0.05), neonatal birth weight <3.2 kg (p<0.05) and spontaneous onset of labour (p<0.05) were significant predictors. Multivariable logistic regression identified scar thickness >3 mm and Bishop score >6 as independent predictors.
Conclusions: TOLAC after ≥2 previous LSCS can be safely offered to carefully selected women. Integration of scar thickness and cervical favourability into structured institutional selection protocols improves VBAC success rates and supports evidence-based decision-making.
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