Study of Trial of Labour after Caesarean Section (TOLAC)

Introduction: Caesarean section is one of the most commonly performed major surgical procedures. Worldwide increase in caesarean section (CS) rate during the last three decades has been the cause for concern. As ours is a tertiary health care centre catering around 20,000 deliveries per year and patients with previous caesarean scar get referred from surrounding primary health centers in huge number. In order to reduce c-section rates, TOLAC are conducted as per departmental standard operative procedures and WHO standards. Objective: To study incidence of trial of labour after c-section, progress of labour in active phase, maternal and fetal outcome in cases of trial of labour after c-section at tertiary care center. Methods: Prospective Observational study in tertiary institute from october 2020- september 2022 in the department of obgy. Ethical approval was taken. 200 cases were studied after applying inclusion and exclusion criteria with CTG monitoring. Results: A total of 200 subjects with previous one cesarean section were studied. 71.50% underwent successful trial of vaginal birth (57.50 % vbac, 08.50 % vaccum and 05.50 % forceps) and 28.50% required cesarean section. Maximum number of women who had VBAC has LSCS (Lower Segment Caesarean Section) in the past for fetal distress(33%). LSCS (failed VBAC) was done maximally for fetal distress 37 (64.90%), then for failure to progress 15 (26.30%) and impending scar dehiscence 5 (08.80%). Maternal complications were lower in the VBAC group: fever (0.69%), blood transfusion (06.30 %). Conclusion: Success rate of TOLAC at our institute is 75 %.The study shows encouraging result for VBAC in a well facilitated set up to be followed to reduce Caesarean rate