The rising number of caesarean sections, especially among women who have had one prior surgery (LSCS), has sparked questions over the effectiveness and safety of labour induction techniques. In women having one prior LSCS, this research aimed to examine the results for the mother and foetus after labour induction using Foley's catheter and “Cervical Ripening Balloon (CRB)”. Five hundred pregnant women with a history of one previous LSCS, a gestational age between 37 and 42 weeks, and a favorable Bishop score of less than or equal to four were enrolled in this prospective observational research. Two sets of patients were established: 250 had labour induction via Foley's catheter, and another 250 underwent it via CRB. The effectiveness of labour induction, uterine hyperstimulation, post-induction caesarean section, and maternal complications were among the maternal and foetal outcomes evaluated. The prevalence of foetal distress, the Apgar scores at one and five minutes, and neonatal problems were all considered foetal outcomes. Compared to the Foley group, the CRB group showed significantly higher labour induction efficacy (78.0% vs. 62.0%, p < 0.001) and a reduced incidence of uterine hyperstimulation (11.2% vs. 18.0%, p = 0.045). Although there was no significant difference in the rate of post-induction caesarean sections, there was a trend in the CRB group towards fewer caesarean sections (7.6% vs. 12.0%, p = 0.132). There were comparable maternal problems in each group (p = 0.287). The CRB group had lower rates of foetal distress (8.8% vs. 15.2%, p = 0.021), and their newborns scored higher on the Apgar scale at 1 and 5 minutes (p < 0.001 and p = 0.007, respectively). Complications throughout infancy were similar (p = 0.165). In summary, CRB showed superiority regarding foetal distress incidence, uterine hyperstimulation risk, and efficacy for inducing labour. The CRB group showed trends indicating a lower rate of caesarean sections while maintaining maternal safety. The results are consistent with earlier studies, suggesting that CRB is the better technique for inducing labour in women who have had one previous LSCS. Future research should include larger trials, long-term outcomes, cost-effectiveness, and patient preferences to improve this population's current understanding of labor induction.
TopIntroduction
The rising incidence of caesarean sections, especially in women who have had one prior procedure (LSCS), has drawn attention from the medical community and obstetric research community (Caughey et al., 2009). These patterns have created a pressing need to investigate substitute techniques for inducing labour in such circumstances. Many medical and obstetric grounds frequently lead to the decision to induce labour, and each one necessitates a careful assessment of the best approach (Salim et al., 2018).
Because of worries about uterine rupture during labour, doctors and researchers are reassessing the safest and most efficient ways to induce labour in pregnancies with a history of one prior Caesarean operation (Sayed Ahmed et al., 2016). The conventional method of deciding between a CRB and a Foley’s catheter has become more popular as medical professionals try to maximise foetal and maternal outcomes while lowering the dangers of induction (Shetty et al., 2022). The development of less intrusive, more modern techniques for inducing labour has replaced the more conventional strategy of surgical treatments like hysterotomy or hysterectomy (Atad et al., 1997). Among these non-surgical methods, Foley’s catheter and CRB usage have attracted attention due to their safety and effectiveness profiles (Elaiyaraja et al., 2023). These techniques are meant to encourage uterine contractions, ripen the cervix, and speed up the course of labour (Mei-Dan et al., 2012).
There are particular difficulties when inducing labour in a woman who has had one caesarean section before (Anda-petronela et al., 2017). The risk of uterine rupture during labour may be increased by the probable weakening of the uterine scar left over from the previous surgery (Krishna Vaddy, 2023). As a result, the method of induction chosen becomes critical in deciding the results for both the mother and the foetus (Kothuru, 2023). Foetal well-being, namely concerning suffering throughout the induction process, and maternal safety, specifically about rates of caesarean section and uterine hyperstimulation, are of utmost importance (Salim et al., 2011).
The necessity for safe and efficient labour induction techniques has become more apparent due to the rising incidence of caesarean sections, a key surgical intervention in obstetrics, throughout the world, especially among women who have had one prior Caesarean section (LSCS) (Atad et al., 1996). LSCS affects not just the first birth experience but also subsequent pregnancies and delivery choices (Boopathy, 2023). As a result, managing labour induction in this particular demographic poses a difficult and complicated clinical situation (Cheuk et al., 2015).
Healthcare professionals are reassessing how they manage labour induction, particularly for women who want a “vaginal birth after caesarean (VBAC)”, in light of the growing trend of primary and repeat Caesarean procedures (Hemalatha & Swetha, 2017). A number of variables, including mother preferences, worries about the hazards of repeat Caesarean sections, and the possibility of difficulties from uterine scarring in following pregnancies, have contributed to this change in clinical practise.
The “American College of Obstetricians and Gynaecologists (ACOG)” emphasises that the patient and healthcare practitioner should work together to make the decision and recognises the significance of giving women who have had one prior LSCS the option of a VBAC. The selection of a labour induction technique becomes an essential component of care in this situation.