Committee opinion. Induction of labor for vaginal birth after cesarean delivery.

A recent population-based study of vaginal birth after cesarean delivery (VBAC) attempts observed uterine rupture rates of 24.5 per 1,000 with prostaglandin-induced labor, while the uterine rupture rates with spontaneous labor and labor induced without prostaglandins were lower (5.2/1,000 and 7.71/1,000 respectively). The authors did not confirm the diagnoses by examining individual medical records, so the actual incidence of uterine rupture may have been overstated. Despite this limitation, the Committee on Obstetric Practice concludes that the risk of uterine rupture during VBAC attempts is substantially increased with the use of various prostaglandin cervical ripening agents for the induction of labor, and their use for this purpose is discouraged.