Abstract
Background: Cesarean delivery has become the most common major surgical procedure in many parts of the world. Induction of labor in women with prior cesarean delivery is an alternative to mitigate the rising cesarean rates. Objectives: To compare the VBAC success rate between two vaginal forms of dinoprostone for labor induction in women with prior cesarean section. Material and Methods: A pilot study was conducted at a large Governmental Hospital, Dhahran, Saudi Arabia, including 200 women with prior cesarean section and planned for labor induction. Participants were randomly allocated into two groups. Group A (n = 100) received dinoprostone 1.5 mg vaginal tablet. Group B (n = 100) received 10 mg dinoprostone sustained release vaginal pessary. Primary outcome was vaginal delivery rate. Secondary outcomes included maternal and neonatal outcomes. Results: The dinoprostone vaginal tablet and dinoprostone vaginal pessary had a comparable vaginal delivery rate (67% and 64%, respectively; p = 0.78). The median patient satisfaction with the birth process was superior in the dinoprostone vaginal pessary group (p = 0.04). Maternal and neonatal outcomes were similar in both groups. Conclusion: Both forms of dinoprostone were effective methods for labor induction in women with prior cesarean section. However, the patient satisfaction with the birth process was in favor of the dinoprostone sustained release vaginal pessary.
Highlights
Cesarean section has become the most common major surgical intervention in various portions of the world [1]
Seventy one women declined from the study as they were not meeting the criteria for inclusion (n = 29) or refusing induction of labor (n = 42)
Our results demonstrated a low rate of uterine rupture (0.5%) in the 200 women attempting vaginal birth after cesarean section (VBAC) with induced labor
Summary
Cesarean section has become the most common major surgical intervention in various portions of the world [1]. It is well recognized that the hazards of cesarean delivery for women rise with increasing amounts of cesarean sections These involve possibly life-threatening complications including hemorrhage, surgical complications and morbidly adherent placenta [3,4]. Induction of labor in women with prior cesarean delivery is an alternative to mitigate the rising cesarean rates. Objectives: To compare the VBAC success rate between two vaginal forms of dinoprostone for labor induction in women with prior cesarean section. Group B (n = 100) received 10 mg dinoprostone sustained release vaginal pessary. The median patient satisfaction with the birth process was superior in the dinoprostone vaginal pessary group (p = 0.04). The patient satisfaction with the birth process was in favor of the dinoprostone sustained release vaginal pessary
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