Oxytocin Versus Dinoprostone Vaginal Insert for Induction of Labor After Previous Cesarean Delivery: A Retrospective Comparative Study

Abstract

The practice guidelines of several medical societies accept both spontaneous labor and labor induction as safe and useful approaches to lower the rate of cesarean delivery in women with history of a cesarean delivery. Dinoprostone (prostaglandin E2) vaginal insert and continuous oxytocin infusion are commonly used induction methods. Both may be associated with increased risk of uterine rupture. There is no consensus as to which is more effective or safer. This retrospective study compared the efficacy and safety between the dinoprostone vaginal insert and oxytocin in pregnant women with a history of cesarean delivery. The study was conducted between 2001 and 2008 in 526 pregnant women with induced labor who had a previous cesarean. The women were divided into 2 groups: 247 were induced with a dinoprostone vaginal insert 10 mg and 279 women were induced with a continuous infusion of oxytocin. Both induction methods were evaluated for vaginal delivery rate, maternal and neonatal morbidity, and newborn mortality. Vaginal deliveries were achieved in 65.2% of the women. The data showed no significant difference between these methods in rates of cesarean delivery (35.6% dinoprostone vs. 34.1% oxytocin, P = 0.71). Uterine rupture occurred in 9 cases (corresponding to a rate of 1.7%); of these, 4 had been induced with dinoprostone vaginal insert and the remaining 5 with oxytocin (P = 0.89). There were no significant differences between these induction methods in the outcomes of fetal morbidity or mortality. These findings show that both dinoprostone vaginal insert and oxytocin infusion are equally safe and effective methods for induction in women with a history of cesarean delivery.