Abstract
Background: Vaginal dinoprostone (PGE2) is currently used as the prostaglandin of choice in many obstetric units. However, few studies have evaluated its safety, especially in women who previously had a cesarean section. Objective: To evaluate the efficacy and safety of PGE2 in pregnant women who are undergoing induction of labor (IOL), and who have had a previous cesarean section. Materials and Methods: A prospective observational study was conducted in La Mancha Centro Hospital in Alcázar de San Juan, Spain, from 1 February 2019 to 30 August 2020. Obstetric and neonatal outcomes, following IOL with PGE2, in 47 pregnant women who wanted a trial of labor after cesarean (TOLAC), and 377 pregnant women without a history of cesarean section, were analyzed. The outcomes were analyzed by bivariate and multivariate analyses using binary and multiple linear regression. Results: A total of 424 women were included in this study. The percentage of cesarean sections in the TOLAC group was 44.7% (21), compared with 31.6% (119) in the group without a history of cesarean section (adjusted odds ratio: 1.4; 95% CI: 0.68–2.86). In the multivariate analysis, no statistically significant differences were observed between both groups for obstetric and neonatal outcomes (p > 0.05). However, two uterine ruptures (4.3%) occurred in the group of patients with a history of cesarean section who underwent IOL with PGE2. Conclusions: The induction of labor with vaginal dinoprostone (PGE2), in patients with a previous history of cesarean section, was not associated with worse obstetric or neonatal outcomes compared with the group of patients without a history of cesarean section in our study sample. However, further research is needed regarding this IOL method, and it should be used with caution in this population group.
Highlights
Induction of labor (IOL) is an obstetric procedure that is conducted with increasing frequency worldwide, reaching a percentage of 29.4% in some countries, such as the US [1].induction of labor (IOL) is indicated when there is an increased risk for the mother or the fetus to continue the pregnancy
This is due to the lower rate of tachysystole with changes in fetal heart rate (FHR) [6], as well as the lack of conclusive results suggesting an increased risk of uterine rupture compared to pharmacological dilation [7,8]
The study population included a consecutive sample of singleton pregnancies in cephalic presentation with a history of previous cesarean section, desire to trial labor after cesarean (TOLAC), and with a medical indication for IOL and cervical ripening with prostaglandin E2 (PGE2), following the guidelines of the Spanish Society of Gynecology and Obstetrics [11]
Summary
IOL is indicated when there is an increased risk for the mother or the fetus to continue the pregnancy In those pregnant women who have previously undergone a cesarean section, and who wish to trial vaginal delivery, IOL is a valid option. Among the cervical ripening methods available, mechanical dilation with a balloon catheter is the method of choice recommended by some scientific societies, such as ACOG or SOGC, in patients with a previous cesarean section This is due to the lower rate of tachysystole with changes in fetal heart rate (FHR) [6], as well as the lack of conclusive results suggesting an increased risk of uterine rupture compared to pharmacological dilation [7,8]
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