Abstract
Objective: To review the outcome of prostaglandin induction of labor in term pregnant women with previous one ce-sarean section compared to those without previous Cesarean section. Design: 18 years retrospective review of hospital records and case note review of index cases. Setting: University hospital. Population: Three hundred and twenty two women who had their labor induced with prostaglandin E2. One hundred and sixty one women had one previous Ce-sarean section. Methods: This study was conducted at King Fahad University Hospital, University of Dammam. It is a tertiary referral center with approximately 2300 births per year. We searched the hospital's records of deliveries from January 1992 to December 2009 and reviewed all indications and outcomes of prostaglandin induction of labor in women with one previous Cesarean section. The control group was composed of women who had their labor induced with prostaglandin but without previous Cesarean section. Main outcome measures: Labor outcome and uterine rup-ture Results: Three hundred and twenty two women were included. All received prostaglandin E2 for induction of labor. One hundred and sixty one women had one previous Cesarean section (study group) and the rest had no previous Ce-sarean section (control group). There was no difference in the rate of vaginal delivery between study and control group, 68.3% and 79.5% (p value 0.3), respectively. The rate of uterine rupture was 30 times higher in study group (2.5% Vs 0.033%). Conclusion: In women with one previous Cesarean section, induction of labor with prostaglandin leads to comparable rate of vaginal delivery similar to those without prior Cesarean section but with relatively high risk of uter-ine rupture.
Highlights
Before the 1970s, deliveries by Cesarean section were considered as an indication for cesarean section in subsequent deliveries
Of the total number of women admitted to labor room, 161 had previous one Cesarean section and labor was induced with prostaglandin
The Cesarean section rate increased markedly in our hospital from 8% in 1992 to 23% in 2009. This higher rate combined with larger family size and closer spacing in our community will inevitably lead to large number of women with multiple Cesarean sections
Summary
Before the 1970s, deliveries by Cesarean section were considered as an indication for cesarean section in subsequent deliveries. In the 1980s the dictum “once a Cesarean, always a Cesarean” was revised and attempt of vaginal delivery after Cesarean section (VBAC) was proposed to reduce the Cesarean section rate. The VBAC rate increased from 3% in 1980 to 28.3% in 1996, but this was not associated with decrease in Cesarean section rate [1]. There has been a dramatic rise in Cesarean section rate over the last decades. The Cesarean section rate increased from 5.5% in 1970 to 31.8% in 2007, about one mother in three gives birth by cesarean section, a record level for the United States [2].
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