Sven Kehl1,2, Christel Weiss3, Michael Wamsler4, Jana Beyer5, Ulf Dammer6, Jutta Heimrich6, Florian Faschingbauer6, Marc Sütterlin7, Matthias W Beckmann6, Ekkehard Schleussner5. 1. Department of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstraße 21-23, 91054, Erlangen, Germany. sven.kehl@gmail.com. 2. Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany. sven.kehl@gmail.com. 3. Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany. 4. Department of Obstetrics and Gynecology, Hospital Memmingen, Memmingen, Germany. 5. Department of Obstetrics, Jena University Hospital, Jena, Germany. 6. Department of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstraße 21-23, 91054, Erlangen, Germany. 7. Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany.
Abstract
PURPOSE: To evaluate the efficacy of inducing labor using a double-balloon catheter and vaginal prostaglandin E2 (PGE2) sequentially, in comparison with vaginal PGE2 alone after previous cesarean section. METHODS: A total of 264 pregnant women with previous cesarean section undergoing labor induction at term were included in this prospective multicentre cohort study. Induction of labor was performed either by vaginal PGE2 gel or double-balloon catheter followed by vaginal PGE2. The primary outcome measure was the cesarean section rate. RESULTS: The cesarean section rate was 37 % without any statistically significant difference between the two groups (PGE2: n = 41, 37 % vs. balloon catheter/PGE2: n = 41, 42 %; P = 0.438). The median (range) number of applications of PGE2 [2 (1-10) versus 1 (0-8), P < 0.001] and the total amount of PGE2 used in median (range) mg [2 (1-15) vs. 1 (0-14), P = 0.001] was less in the balloon catheter/PGE2 group. Factors significantly increasing risk for cesarean section were "no previous vaginal delivery" (OR 5.391; CI 2.671-10.882) and "no oxytocin augmentation during childbirth" (OR 2.119; CI 1.215-3.695). CONCLUSIONS: The sequential application of double-balloon catheter and vaginal PGE2 is as effective as the sole use of vaginal PGE2 with less applications and total amount of PGE2.
PURPOSE: To evaluate the efficacy of inducing labor using a double-balloon catheter and vaginal prostaglandin E2 (PGE2) sequentially, in comparison with vaginal PGE2 alone after previous cesarean section. METHODS: A total of 264 pregnant women with previous cesarean section undergoing labor induction at term were included in this prospective multicentre cohort study. Induction of labor was performed either by vaginal PGE2 gel or double-balloon catheter followed by vaginal PGE2. The primary outcome measure was the cesarean section rate. RESULTS: The cesarean section rate was 37 % without any statistically significant difference between the two groups (PGE2: n = 41, 37 % vs. balloon catheter/PGE2: n = 41, 42 %; P = 0.438). The median (range) number of applications of PGE2 [2 (1-10) versus 1 (0-8), P < 0.001] and the total amount of PGE2 used in median (range) mg [2 (1-15) vs. 1 (0-14), P = 0.001] was less in the balloon catheter/PGE2 group. Factors significantly increasing risk for cesarean section were "no previous vaginal delivery" (OR 5.391; CI 2.671-10.882) and "no oxytocin augmentation during childbirth" (OR 2.119; CI 1.215-3.695). CONCLUSIONS: The sequential application of double-balloon catheter and vaginal PGE2 is as effective as the sole use of vaginal PGE2 with less applications and total amount of PGE2.
Authors: Aireen Wingert; Lisa Hartling; Meghan Sebastianski; Cydney Johnson; Robin Featherstone; Ben Vandermeer; R Douglas Wilson Journal: BMC Pregnancy Childbirth Date: 2019-12-30 Impact factor: 3.007