Induction of labor with prostaglandin E 2 in women with previous cesarean section and unfavorable cervix

Abstract

Objective: To study the pregnancy outcome of induction of labor with prostaglandin E2 (PGE 2) in women with one previous lower segment cesarean section. Methods: A retrospective cohort design was used. The study sample included 1028 consecutive women with one previous cesarean section, of whom 97 underwent induction of labor (study group) and 931 were admitted with spontaneous onset of labor (control group). Vaginal tablets of PGE 2 were used for cervical ripening in the study group. Mode of delivery, neonatal outcome, indications for cesarean section, and rate of uterine rupture were compared between the groups. Results: There were no significant differences between the study and control groups in mean (±S.D.) maternal age (30.9±4.7 years versus 31.2±4.8 years, P=0.6), gestational age at delivery (39.2±1.8 weeks versus 39.3±1.6 weeks, P=0.36), overall rate of cesarean section (36% versus 37.3%, P=0.8), rates of low 5-min Apgar score ≤7 (3.1% versus 3.7%, P=0.67) or cesarean section performed for nonreassuring fetal heart rate (6.1% versus 3.1%, P=0.1). There were four cases of uterine rupture, all in the control group compared to none in the study group (nonsignificant). Conclusion: The findings suggest that induction of labor in women with one previous cesarean section does not increase the risk of cesarean section rate and does not adversely affect immediate neonatal outcome. We cautiously suggest that when there is no absolute indication for repeated cesarean section, induction of labor may be considered.