Effect of a Locally Tailored Clinical Pathway Tool on VBAC Outcomes in a Private Hospital in India



Customized clinical and administrative interventions in the form of a care pathway tool can improve VBAC outcomes and reduce the alarming rise in caesarean sections globally.


To determine the effect of a locally tailored clinical pathway tool on VBAC outcomes in a private hospital in India.


A pre- and post-implementation study was conducted in a private hospital in India. All women with one previous caesarean section term pregnancy and cephalic presentation were included at baseline from January 2013 to December 2015 (Phase 1) and from January 2016 to December 2018 (Phase 2) after ongoing implementation of a clinical pathway tool by all providers. Background characteristics and clinical outcomes in both phases were reviewed retrospectively from case files.


Overall 223 (13.42%) women among 1661 total births and 244 (11.62%) women among 2099 total births were included in Phase 1 and Phase 2, respectively. Total number of women who underwent trial of labour (TOLAC) increased from 36.77% to 64.34% (P < 0.001) and VBAC rate increased from 23.76% to 58.19% (P < 0.001) in Phase 2. There was no significant difference in perinatal morbidity and mortality in the two phases.


A locally customized clinical care pathway tool implemented to support both mothers and care givers for TOLAC seemed to improve VBAC outcomes in a private setting in India.

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We are grateful to Mr. Abhishek Bhartia, CEO of the hospital, for continuous encouragement and administrative support. In particular, we would like to thank the senior providers Dr Swati Sinha, Dr Anita Sabherwal, Dr Priti Arora and Dr Payal Chaudhary for their clinical contribution. Furthermore, we would like to thank Pradya, quality officer, for data collection.

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Correspondence to Nikita Kumari.

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Nikita Kumari, Neeru Jain and Rinku Sen Gupta Dhar declare that they have no conflict of interest.

Research Involving Human Participants and Informed Consent

Our study involved anonymous review of relevant clinical parameters from case records, before and after implementation of a clinical care pathway tool which was a bundle of evidence-based practices. No consent was taken as data were collected from case records retrospectively. Ethical approval was taken from institutional ethics committee.

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Nikita Kumari is a DNB Obstetrics & Gynaecology, Attending Consultant, Department of Obstetrics & Gynaecology at Sitaram Bhartia Institute of Science & Research, B-16 Qutab Institutional Area, New Delhi, 110016, India ; Neeru Jain is DGO Obstetrics & Gynaecology, Attending Consultant, Department of Obstetrics & Gynaecology at Sitaram Bhartia Institute of Science & Research, B-16 Qutab Institutional Area, New Delhi, 110016, India; Rinku Sen Gupta Dhar is MD Obstetrics & Gynaecology, Senior Consultant, Department of Obstetrics & Gynaecology at Sitaram Bhartia Institute of Science & Research, B-16 Qutab Institutional Area, New Delhi, 110016, India

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Kumari, N., Jain, N. & Dhar, R.S.G. Effect of a Locally Tailored Clinical Pathway Tool on VBAC Outcomes in a Private Hospital in India. J Obstet Gynecol India (2021). https://doi.org/10.1007/s13224-021-01446-5

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  • Vaginal birth after caesarean section (VBAC)
  • Trial of labour after caesarean (TOLAC)
  • Elective repeat caesarean section (ERCS)
  • VBAC attempt rate
  • VBAC rate
  • VBAC success rate
  • Clinical care pathway
  • Robson V