David Stenson1, Tove Wallstrom1, Maria Sjostrand1, Helena Akerud2, Kristina Gemzell-Danielsson3, Eva Wiberg-Itzel1. 1. a Department of Clinical Science and Education , Section of Obstetrics and Gynecology, Karolinska Institute, Soder Hospital , Sweden . 2. b Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden , and. 3. c Department of Women's and Children's Health , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.
Abstract
OBJECTIVE: To evaluate the frequency of uterine rupture following induction of labor in women with a previous cesarean section. Misoprostol was compared to other methods of induction. METHODS: A retrospective cohort study of 208 women attempting induction of labor after one previous cesarean section. Delivery data were collected retrospectively and compared. Group 1(2009-2010) was compared with Group 2 (2012-2013). In Group 1, the main method of induction was vaginal PGE2 (prostaglandin-E2), amniotomy, oxytocin or a balloon catheter. In Group 2, the dominant method of induction was an oral solution of misoprostol. MAIN OUTCOME MEASURES: frequency of uterine rupture in the two groups. RESULTS: Nine cases (4.3%) of uterine rupture occurred. There was no significant difference in the frequency of uterine rupture following the change of method of induction from PGE2, amniotomy, oxytocin or mechanical dilatation with a balloon catheter to orally administered misoprostol (4.1 versus 4.6%, p = 0.9). All ruptures occurred in women with no prior vaginal delivery. CONCLUSION: The shift to oral misoprostol as the primary method of induction in women with a previous cesarean section did not increase the frequency of uterine rupture in the cohort studied.
OBJECTIVE: To evaluate the frequency of uterine rupture following induction of labor in women with a previous cesarean section. Misoprostol was compared to other methods of induction. METHODS: A retrospective cohort study of 208 women attempting induction of labor after one previous cesarean section. Delivery data were collected retrospectively and compared. Group 1(2009-2010) was compared with Group 2 (2012-2013). In Group 1, the main method of induction was vaginal PGE2 (prostaglandin-E2), amniotomy, oxytocin or a balloon catheter. In Group 2, the dominant method of induction was an oral solution of misoprostol. MAIN OUTCOME MEASURES: frequency of uterine rupture in the two groups. RESULTS: Nine cases (4.3%) of uterine rupture occurred. There was no significant difference in the frequency of uterine rupture following the change of method of induction from PGE2, amniotomy, oxytocin or mechanical dilatation with a balloon catheter to orally administered misoprostol (4.1 versus 4.6%, p = 0.9). All ruptures occurred in women with no prior vaginal delivery. CONCLUSION: The shift to oral misoprostol as the primary method of induction in women with a previous cesarean section did not increase the frequency of uterine rupture in the cohort studied.
Entities:
Keywords:
Induction of labor; PGE2; TOLAC; misoprostol; uterine scar