4.1. Strengths and Limitations
rupture, oligohydramnios
FAILED INDUCTION, RECRUITMENT, DILATION, OLIGOHYDRAMNIOS, COMPLICATIONS
Our study is a pilot randomized controlled trial. The two groups were comparable for essential variables like the Bishop score and previous vaginal delivery that are known to influence VBAC rates. We had a strict induction protocol for both groups. We excluded any maternal or foetal complications requiring induction, including oligohydramnios at the time of recruitment at 40 weeks. Since we followed standard induction protocol and monitoring, we can generalise the results to most tertiary centres with infrastructure for delivering women with previous caesarean pregnancy. There can be potential bias as there was no blinding. The limitation of our study is as follows: the sample size was small and could not have detected any harm. We did not power the sample size for perinatal or maternal outcomes. To calculate the sample size, we presumed that all participants in the expectant group are likely to have spontaneous labour, but this may not be the reality always. We terminated labour by caesarean section if the women failed to enter the active phase of labour within 6-8 hours of artificial rupture of membranes. We took 4 cm dilation as the definition for the active phase of labour. The trial of labour did not last longer than 24 hours if the women had not gone into the active phase of labour. We did not give a second application of the Foley if the Bishop score had not improved. However, since the induction protocol was the same for both groups, this definition of active labour and failed induction would not have influenced the difference in the vaginal delivery rates.