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Agarwal S, D'Souza R, Dy J. Induction of labour in patients with prior caesarean births or uterine surgery. Best Pract Res Clin Obstet Gynaecol 2021; 79:95-106. [PMID: 35012884 DOI: 10.1016/j.bpobgyn.2021.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/02/2022]
Abstract
The current evidence favours trial of labour after one caesarean in the absence of any other contraindications, recognizing that risks with both trial of labour after caesarean (TOLAC) and elective repeat caesarean section (ERCS) birth are relatively uncommon. When the need for induction of labour (IOL) following a previous caesarean arises, shared decision-making should be based on the current available evidence. This approach, however, needs to be tailored, taking into account the individual's history, initial examination and response to the ongoing process of induction to optimize the maternal and foetal outcomes. This paper aims to review the evidence and provide guidance on decision making surrounding labour induction in a pregnancy following a prior caesarean or uterine surgery.
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Affiliation(s)
- Sugandha Agarwal
- Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, K1H8L6, ON, Canada.
| | - Rohan D'Souza
- Department of Obstetrics and Gynecology, McMaster University, 501 Smyth Road, Ottawa, K1H8L6, ON, Canada.
| | - Jessica Dy
- Department of Obstetrics and Gynecology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H8L6, Canada.
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López-Jiménez N, García-Sánchez F, Pailos RH, Rodrigo-Álvaro V, Pascual-Pedreño A, Moreno-Cid M, Hernández-Martínez A, Molina-Alarcón M. Induction of Labor with Vaginal Dinoprostone (PGE 2) in Patients with a Previous Cesarean Section: Obstetric and Neonatal Outcomes. J Clin Med 2021; 10:5221. [PMID: 34830502 PMCID: PMC8622073 DOI: 10.3390/jcm10225221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/01/2021] [Accepted: 11/07/2021] [Indexed: 12/02/2022] Open
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.
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Affiliation(s)
- Nuria López-Jiménez
- Department of Obstetrics and Gynecology, La Mancha Centro Hospital, 13600 Alcázar de San Juan, Spain; (N.L.-J.); (F.G.-S.); (R.H.P.); (V.R.-Á.); (A.P.-P.); (M.M.-C.)
| | - Fiamma García-Sánchez
- Department of Obstetrics and Gynecology, La Mancha Centro Hospital, 13600 Alcázar de San Juan, Spain; (N.L.-J.); (F.G.-S.); (R.H.P.); (V.R.-Á.); (A.P.-P.); (M.M.-C.)
| | - Rafael Hernández Pailos
- Department of Obstetrics and Gynecology, La Mancha Centro Hospital, 13600 Alcázar de San Juan, Spain; (N.L.-J.); (F.G.-S.); (R.H.P.); (V.R.-Á.); (A.P.-P.); (M.M.-C.)
| | - Valentin Rodrigo-Álvaro
- Department of Obstetrics and Gynecology, La Mancha Centro Hospital, 13600 Alcázar de San Juan, Spain; (N.L.-J.); (F.G.-S.); (R.H.P.); (V.R.-Á.); (A.P.-P.); (M.M.-C.)
| | - Ana Pascual-Pedreño
- Department of Obstetrics and Gynecology, La Mancha Centro Hospital, 13600 Alcázar de San Juan, Spain; (N.L.-J.); (F.G.-S.); (R.H.P.); (V.R.-Á.); (A.P.-P.); (M.M.-C.)
| | - María Moreno-Cid
- Department of Obstetrics and Gynecology, La Mancha Centro Hospital, 13600 Alcázar de San Juan, Spain; (N.L.-J.); (F.G.-S.); (R.H.P.); (V.R.-Á.); (A.P.-P.); (M.M.-C.)
| | - Antonio Hernández-Martínez
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Man cha IDINE, Camilo José Cela, 14, 13071 Ciudad Real, Spain;
| | - Milagros Molina-Alarcón
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Man cha IDINE, Camilo José Cela, 14, 13071 Ciudad Real, Spain;
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Chiossi G, D’Amico R, Tramontano AL, Sampogna V, Laghi V, Facchinetti F. Prevalence of uterine rupture among women with one prior low transverse cesarean and women with unscarred uterus undergoing labor induction with PGE2: A systematic review and meta-analysis. PLoS One 2021; 16:e0253957. [PMID: 34228760 PMCID: PMC8259955 DOI: 10.1371/journal.pone.0253957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As uterine rupture may affect as many as 11/1000 women with 1 prior cesarean birth and 5/10.000 women with unscarred uterus undergoing labor induction, we intended to estimate the prevalence of such rare outcome when PGE2 is used for cervical ripening and labor induction. METHODS We searched MEDLINE, ClinicalTrials.gov and the Cochrane library up to September 1st 2020. Retrospective and prospective cohort studies, as well as randomized controlled trials (RCTs) on singleton viable pregnancies receiving PGE2 for cervical ripening and labor induction were reviewed. Prevalence of uterine rupture was meta-analyzed with Freeman-Tukey double arcsine transformation among women with 1 prior low transverse cesarean section and women with unscarred uterus. RESULTS We reviewed 956 full text articles to include 69 studies. The pooled prevalence rate of uterine rupture is estimated to range between 2 and 9 out of 1000 women with 1 prior low transverse cesarean (5/1000; 95%CI 2-9/1000, 122/9000). The prevalence of uterine rupture among women with unscarred uterus is extremely low, reaching at most 0.7/100.000 (<1/100.000.000; 95%CI <1/100.000.000-0.7/100.000, 8/17.684). CONCLUSIONS Uterine rupture is a rare event during cervical ripening and labor induction with PGE2.
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Affiliation(s)
- Giuseppe Chiossi
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto D’Amico
- Statistics Unit, Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna L. Tramontano
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Veronica Sampogna
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Viola Laghi
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
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Parveen S, Rengaraj S, Chaturvedula L. Factors associated with the outcome of TOLAC after one previous caesarean section: a retrospective cohort study. J OBSTET GYNAECOL 2021; 42:430-436. [PMID: 34151688 DOI: 10.1080/01443615.2021.1916451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The factors associated with the outcome of trial of labour after one previous Caesarean Section; a retrospective cohort study. A retrospective observational study was performed on all eligible consecutive singleton pregnancies planned for trial of labour after one previous Caesarean Section (TOLAC) over a period of 18 months to study the success rate of vaginal birth after Caesarean Section (VBAC) and to find out the factors associated with successful and failed TOLAC. All of the data were entered in electronic format and the data was analysed in detail. Of the 1324 women studied, the VBAC rate was 65.3% and the incidence of scar rupture was 0.5%. The composite adverse maternal (postpartum haemorrhage and intensive care admission) and foetal outcome (still birth, 5-minute APGAR <7 and NICU admission) was more in the failed TOLAC group. Various demographic, clinical and obstetric factors were studied in detail between the successful and failed TOLAC groups. The favourable Bishop Score (>4) was independently associated with successful TOLAC (OR 4.3; 95% CI 3.3-5.6 p < .001). Maternal age of >30 years, (OR 0.57; 95% CI 0.41-0.79; p = .001), labour induction (OR 0.43; 95% CI 0.33-0.56; p < .001) and estimated foetal weight of >3500 g (0.31; 95% CI 0.14-0.6; p = .002) were the factors independently associated with failed TOLAC. Previous indication for a Caesarean Section and previous vaginal delivery were not found to be independently associated with the outcome of TOLAC. The predictive models for TOLAC need to be used cautiously and the risk assessment should be done on an individual basis.IMPACT STATEMENTWhat is already known on this subject? TOLAC is a reasonable strategy in Obstetrics especially after one Caesarean Section to minimise the morbidity associated with rising Caesarean Section. However, the maternal and foetal morbidity are more following unsuccessful TOLAC. The factors which predict the outcome of TOLAC are multifactorial which include maternal demographic factors, previous obstetric factors like indication for Caesarean Section, intraoperative complications, inter-pregnancy interval, current obstetric factors such as gestational age, Bishop Score before delivery, labour factors and foetal factors, e.g. sex and foetal size.What do the results of this study add? We tried to include all the possible factors which probably influence TOLAC and found only Bishop Score, maternal age, foetal size and labour induction were the factors independently associated with the outcome of TOLAC. A Bishop Score of >4 admission was the greatest predictor of successful TOLAC (OR 4.3). Similarly, labour induction and foetal size of >3.5 kg were associated with 60% and 70% less chance of VBAC, respectively.What are the implications of these findings for clinical practice and/or further research? The factors found to be associated with successful and failed TOLAC may be utilised to develop a predictive model. More so, prospective studies are needed to test such predictive models.
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Affiliation(s)
- Shaina Parveen
- Department of Obstetrics and Gynaecology, JIPMER, Puducherry, India
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Bullough S, Southward J, Sharp A. Vaginal prostaglandin E 2 versus double-balloon catheter for induction of labour for vaginal birth after caesarean section: A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2021; 259:90-94. [PMID: 33610830 DOI: 10.1016/j.ejogrb.2021.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the success of the double-balloon catheter (DBC) versus prostaglandin gel (PGE2) for induction of labour in women with one previous caesarean section. DESIGN Retrospective cohort study using routinely collected maternity data in a Tertiary NHS hospital, North West England, UK. Women with a live singleton cephalic pregnancy induced using DBC or PGE2 after one previous birth by caesarean section from 1st April 2017 to 1st July 2019 were included. The core outcomes assessed were the inability to perform artificial rupture of membranes, requirement of oxytocin, vaginal birth and uterine rupture. RESULTS 208 women met the inclusion criteria, 127 were induced using the DBC and 81 using PGE2. The two groups were well matched for demographics and characteristics. Women induced for prolonged ruptured membranes with PGE2 were excluded from the study leaving 127 managed with DBC and 69 with PGE2. There were no significant differences observed between the two groups. Vaginal birth rates were 52.7% for the DBC and 66.6% for the PGE2 (relative risk 0.79 (confidence interval 0.63-1.00); P = 0.05). A single uterine rupture was reported following DBC usage. CONCLUSIONS The DBC and PGE2 appear to be equally effective for induction of labour in women with one previous caesarean section.
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Affiliation(s)
- Siân Bullough
- Harris Wellbeing Research Centre, University of Liverpool and Liverpool Women's Hospital, Members of Liverpool Health Partners, United Kingdom; Liverpool Women's Hospital, Member of Liverpool Health Partners, United Kingdom.
| | - Jessica Southward
- Liverpool Women's Hospital, Member of Liverpool Health Partners, United Kingdom
| | - Andrew Sharp
- Harris Wellbeing Research Centre, University of Liverpool and Liverpool Women's Hospital, Members of Liverpool Health Partners, United Kingdom; Liverpool Women's Hospital, Member of Liverpool Health Partners, United Kingdom
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Obstetric outcome of induction of labor using prostaglandin gel in patients with previous one cesarean section. Obstet Gynecol Sci 2019; 62:397-403. [PMID: 31777735 PMCID: PMC6856483 DOI: 10.5468/ogs.2019.62.6.397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/18/2019] [Accepted: 05/08/2019] [Indexed: 12/02/2022] Open
Abstract
Objective After globally acceptance of planned vaginal birth after cesarean section (VBAC), the mode of induction is still a matter of debate and requires further discussion. We aimed to study obstetric outcomes in post-cesarean patients undergoing induction of labor with prostaglandin gel compared with patients who developed spontaneous labor pains. Methods All patients at 34 weeks or more of gestation with previous one cesarean section eligible for trial of labor after cesarean section admitted in a labor room within one year were divided in 2 groups. Group one consisted of patients who experienced the spontaneous onset of labor pains and group 2 consisted of patients who underwent induction of labor with prostaglandin gel. They were analyzed for maternofetal outcomes. Descriptive statistics, independent sample t-test, and chi-square test were applied using SPSS 20 software for statistical analysis. Results Both groups were comparable in maternal age, parity, and fetal weight, but different in bishop score, mode of delivery, and neonatal outcome. Admisson bishop score was 6.61±2.51 in group 1 and 3.15±1.27 in group 2 (P<0.005). In the patients who experienced spontaneous labor, 86.82% had successful VBAC. In the patients with induced labor, 64.34% had successful VBAC with an average dose of gel of 1.65±0.75. Both groups had one case each of uterine rupture. The neonatal intensive care unit admission rate was 4.1% in group one and 10.4% in group 2. Conclusion This study reflects that supervised labor induction with prostaglandin gel in previous one cesarean section patients is a safe and effective option.
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Al-Talib A, Haseeb Y, Chohan M, Al-Mulhim A. Induction of Labour With Prostaglandin Gel in Grand Multipara with a Previous Caesarean Delivery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:942-946. [PMID: 30578130 DOI: 10.1016/j.jogc.2018.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/01/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study sought to evaluate the safety of induction of labour with prostaglandin E2 (PGE2) gel in grand multiparous (GMP) women and to compare the labour outcome of GMP women who have undergone one previous Caesarean section (CS) with that of GMP women who never had a previous CS. METHODS This prospective cohort study (Canadian Task Force Classification II-2) evaluated induction of labour with 1 mg of PGE2 gel in 96 GMP women with one previous CS (study group) and in 104 GMP women without previous CS (control group). RESULTS One uterine rupture occurred in the study group (1%), and another occurred in the control group (0.9%). Additional oxytocin was used in seven patients (7.3%) in the study group and in 28 others (26.9%) in the control group (P = 0.002). Both uterine ruptures occurred with oxytocin augmentation. One case of uterine scar dehiscence was found in the study group. There was no significant difference between the study group and the control group regarding the rate of vaginal delivery (74 [77.1%] vs. 78 [75%]) or the rate of CS (21 [21.9%] vs. 24 [23.1%]), respectively. There was no significant difference between the groups in 5-minute Apgar scores ≤7. There was no neonatal death in either group. CONCLUSION A low dose (1.0 mg) of PGE2 gel for induction of labour in GMP women with one previous CS is appropriate and appears to be safe for both mother and baby. Augmentation by oxytocin should be used judiciously.
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Affiliation(s)
- Ayman Al-Talib
- Department of Obstetrics & Gynecology, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Yasmeen Haseeb
- Department of Obstetrics & Gynecology, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Muhammad Chohan
- Department of Obstetrics & Gynecology, Lady Willingdon Hospital, King Edward Medical University, Pakistan
| | - Abdulaziz Al-Mulhim
- Department of Obstetrics & Gynecology, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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