Outcomes of Induction of Labor After One Prior Cesarean (original) (raw)
Related papers
American Journal of Obstetrics and Gynecology, 2000
There has been little investigation of the impact of previous vaginal delivery on morbidity during a trial of labor after cesarean delivery. McMahon et al 1 examined morbidity during labor and delivery in women undergoing a trial of labor versus elective repeat cesarean delivery. These authors examined morbidity with a trial of labor for the subgroup of women who had both previous cesarean and previous vaginal deliveries. Although they found no clear increase in major morbidity with increasing parity, they did not directly compare the morbidity in women with a prior vaginal birth and morbidity in women without a previous vaginal delivery. In addition, because most of the major morbidity was a result of operative injury (73%) and not uterine rupture, it is not possible to discern the association of previous vaginal delivery with uterine rupture from this study.
Archives of Gynecology and Obstetrics, 2022
Purpose: Previous cesarean delivery (CD) is the main risk factor for uterine rupture when attempting a trial of labor. Previous vaginal delivery (PVD) is a predictor for trial of labor after cesarean (TOLAC) success and a protective factor against uterine rupture. We aimed to assess the magnitude of PVD as a protective factor from uterine rupture. Methods : A retrospective cohort study was conducted, including women who underwent TOLACs from 2003-2015. Women with and without PVD were compared. Inclusion criteria were one previous CD, trial of labor at ≥24 weeks' gestation, and cephalic presentation. We excluded pre-labor intrauterine fetal death and fetal anomalies. The primary outcome was uterine rupture. Secondary outcomes were maternal and fetal complications. Logistic regression modeling was applied to analyze the association between PVD and uterine rupture while controlling for confounders. Results: A total of 11,235 women undergoing TOLAC were included, 6,795 of whom had a PVD. Women with PVD had signi cantly lower rates of uterine rupture (0.18% vs. 1.1%; OR 0.19, p<0.001), were less likely to be delivered by an emergency CD (13.2% vs. 39.4%, OR 0.17, p<0.0001), were more likely to undergo labor induction (OR 1.56, p<0.0001), and were less likely to undergo an instrumental delivery (OR 0.14, p<0.001). Logistic regression modeling revealed that PVD was the only independent protective factor, with an aOR of 0.22. Conclusion: PVD is the most important protective factor from uterine rupture in patients undergoing TOLAC. A trial of labor following one CD should therefore be encouraged in these patients. Introduction: Cesarean delivery (CD) rates have increased signi cantly worldwide over the past decades. Latest available data show that 21% of women worldwide gave birth by CD (in 2018) ranging from 5% in sub-Saharan Africa to 43% in Latin America and the Caribbean. It is estimated that at this growth rate, by 2030, 28.5% of women worldwide will give birth by CD. Beyond medical indications, many of the CDs are performed as a result of women's and families' preferences as well as due to health professionals' views and beliefs [1]. Rates of trial of labor after cesarean (TOLAC) have uctuated over time. The main reason for the observed reduction in attempted TOLACs is the concern from uterine rupture, occurring in 0.5% of cases [2-5]. Nevertheless, the potential short-and long-term bene ts of a successful vaginal birth after cesarean (VBAC) and the relatively low incidence of uterine rupture, warrant identi cation of subgroups of women with low risk for such an event, who may substantially bene t from TOLAC. Previous studies concluded that TOLAC is a reasonable option for women with a single past CD [6-9]. It was also demonstrated that vaginal birth history, either before or after the CD, was associated with both higher rates of TOLAC success and lower rates of uterine rupture [10-14]. However, most of these studies
Archives of Gynecology and Obstetrics, 2014
Purpose To systematically review the literature about maternal and neonatal outcomes following induction of labor (IOL) and spontaneous labor (SL) in women with previous cesarean section (PCS). Methods PubMed, Medline, EMBASE, Cochrane library searches; January 2000-February 2013. Inclusion criteria: women attempting labor after PCS, singleton term pregnancies. Women undergoing IOL were compared with women in SL. Method for induction, mode of delivery, uterine rupture/dehiscence, post-partum hemorrhage, emergency hysterectomy and any maternal or neonatal morbidity and mortality were analyzed. MOOSE guidelines were followed. Interstudies heterogeneity was tested. A random effect model was generated if heterogeneity was [25 %. Pooled odds ratio with 95 % confidence interval (OR, 95 % CI) were calculated. Results Eight articles included 4,038 women with IOL (23.2 %) and 13,374 women with SL (76.8 %). IOL was associated with a lower incidence of vaginal delivery (OR 0.66; 95 % CI 0.55-0.80) and higher rates of cesarean section (OR 1.52; 95 % CI 1.26-1.83), uterine rupture/ dehiscence (OR 1.62; 95 % CI 1.13-2.31), and post-partum hemorrhage (OR 1.57; 95 % CI 1.20-2.04), although hysterectomy was similar between the two groups (OR 2.60; 95 % CI 0.52-13.1). Neonatal morbidity was similar after IOL or SL (OR 1.13; 95 % CI 0.75-1.69). Conclusions Induction of labor increases the risk of uterine rupture/dehiscence and of repeat cesarean section.
American Journal of Obstetrics and Gynecology, 2004
whose history included previous cesarean section. Incomplete records were excluded. Information was extracted on race, maternal age, parity, gestational age at delivery, mode of delivery, presentation, infant weight, induction agent, previous uterine scar, number and type of prior cesarean sections. Four study groups were defined: (1) repeat cesarean without labor, (2) spontaneous labor, (3) oxytocin induction, and (4) misoprostol induction.
Induction of Labor and Risk for Emergency Cesarean Section in Women at Term Pregnancy
Journal of Clinical Gynecology and Obstetrics, 2019
Background: Induction of labor has become one of the most common interventions in obstetrics, and because of this we have the increasing number of Cesarean sections. Identifying these risk factors which increase the risk of Cesarean section has become important so that we can induce patients putting them in lower risk of Cesarean section. Cesarean sections should be audited using the obstetrical concepts and parameters for induction of labor. Methods: A prospective case-control study has been conducted among pregnant women between 37-42 weeks of gestation, who were recruited from the labor ward for a period of 1 year. All women enrolled for the study were clinically examined to assess for Bishop's score, obstetric scan and cardiotocography (CTG). Induction was done using tab misoprostol 50 µg 6th hourly for a maximum of four doses in 24 h and augmented with oxytocin if required. In our tertiary hospital in Kolar district of Karnataka we decided to conduct a study with a sample size of 178 patients. We assessed the risk factors in term pregnancies and their delivery outcome following induction. Baseline demographic details along with pregnancy risk factors were taken into account. Induction agent as well as induction to delivery interval with those that underwent Cesarean section was also taken into account. Pregnancy outcome was determined. Results: This study concluded that significant risk factor for Cesarean was primigravida with fetal distress due to oligohydramnios, compared to other risk factors such as preeclampsia, gestational hypertension, postdated pregnancy and gestational diabetes mellitus. Bishops score prior to induction was < 6. Out of these women 43 underwent Cesarean after induction in view of fetal distress for non reassuring nonstress test (NST). Primigravida had a risk of 4.4 times for Cesarean after induction, and absence of oligohydramnios was a protective factor in the study with odds ratio of 0.2. Conclusions: Induction of labor at term has reduced the number of Cesarean sections in our study with a single risk factor.
Outcome of Induction of Labor: A Prospective Study
Annals of International medical and Dental Research, 2016
Background: Induction is defined as artificial initiation of uterine contraction with the aim of achieving the normal vaginal delivery. It is most widely accepted obstetrical intervention worldwide. The most common indication for induction is post dated pregnancy. Objective: To assess the outcome of induction in both mother and baby. Methods: During our study period, 391 patients were selected for induction due to various indications. Most of them were induced with tablet Misoprostol and only those with higher degree of gravida were induced with Dinoprostone gel intracervically and maternal and fetal outcome was seen.Results: Out of 4020 patients, induction rate was 9.72%. Among them 98.2% were induced with Misoprostol. Most of the induced age group was in between 20-30 years of age with primigravida 62%. Among them 48.59% were in between 40-41 weeks of gestation with 93% of having poor bishops score. About 67.7% had normal vaginal delivery with 4.86%, assisted with instrumental delivery. Cesarean section was seen in 32.3% of patients. Most common indications for LSCS were for failed induction (44%). Regarding the fetal outcome 99.7% born alive, 97.92% went to mother side, 2.07% admitted and 0.51% expired. Beside this, 88.7% had birth weight between 2.5 to 3.5 kg and 87.4% had clear liquor and 99.22% had the good apgar score. Conclusion: Though the cesarean section rate is higher in this study in comparison of WHO references to be not more than 15% but still the induction is beneficial in high-risk pregnancy where continuing the pregnancy is more hazardous than to termination.
Archives of Gynecology and Obstetrics, 2013
Purpose To determine the success rate of vaginal birth after cesarean birth (VBAC) and its outcome when labour was induced compared to spontaneous labour. Methods Prospective cohort study of all women who had lower segment caesarian section (LSCS) in any previous delivery and were admitted for a trial of labour after cesarean between April 2010 and March 2011 at a University Hospital. We compared the success rates of VBAC in women who had induction of labour (IOL) to those who came with spontaneous labour. Results During the study period, 320 women who elected to have trial of labour after cesarean and were included in the study, 268 (83.8 %) had spontaneous labour and 52 (16.3 %) had IOL. The most common indications for IOL were post term pregnancy 30 %, diabetes during pregnancy 19 % and prelabour spontaneous rupture of membranes 17 %. There was no difference between both groups in age, previous vaginal delivery and gestational age. In terms of the method of induction, the most commonly used method was transcervical Foley catheter in 21 cases (40.4 %) and then Oxytocin in 19 cases (36.5 %), nine women had combined methods of induction (17.3 %). Prostaglandin E2 was used in three women (5.8 %). The incidence of successful VBAC in spontaneous labour was 72 %, however, when induced, the incidence of successful VBAC was 63.5 %. Compared to the spontaneous labour group, induced women had significantly higher rate of CS (36.5 vs. 28 %; P = 0.026).
Delivery after previous cesarean: a risk evaluation
Obstetrics & Gynecology, 1999
Objective: To examine the risks of vaginal delivery after previous cesarean and to find criteria to help decide whether a trial of labor or an elective repeat cesarean should be preferred. Methods: We evaluated 29,046 deliveries after previous cesarean registered in a pooled database of 457,825 deliveries used to assess quality control in gynecology and obstetrics departments in Switzerland. Results: Among the 17,613 trial-of-labor cases logged (attempt rate 60.64%), the success rate was 73.73% (65.56% after inducing labor and 75.06% after the spontaneous onset of labor). The following complications were significantly more frequent in the previous-cesarean group: maternal febrile episodes (relative risk [RR] 2.77; 95% confidence interval [CI] 2.52, 3.05), thromboembolic events (RR 2.81; CI 2.23, 3.55), bleeding due to placenta previa during pregnancy (RR 2.06; CI 1.70, 2.49), uterine rupture (92 cases; RR 42.18; CI 31.09, 57.24), and perinatal mortality (118 cases, including six associated with uterine rupture; RR 1.33; CI 1.10, 1.62). The postcesarean group also showed a 0.28% rate of peripartum hysterectomy (81 cases; RR 6.07; CI 4.71, 7.83). There was one maternal death in the group, compared with 14 maternal deaths in the group without previous cesarean (no statistical significance). The risk of uterine rupture for patients with previous cesareans was elevated in the trial-of-labor group compared with the group without trial of labor (RR 2.07; CI 1.29, 3.30), but all other maternal risks, including peripartum hysterectomy (RR 0.36; CI 0.23, 0.56), were lower. When comparing the women having a trial of labor, the 70 with uterine rupture more often had induced labor (24.29% compared with 13.92% in the nonrupture group; P ؍ ؍ ؍ .013), had epidural anesthesia (24.29% compared with 8.44%; P < < < .001), had an abnormal fetal heart rate tracing (32.86% compared with 8.53%; P < < < .001), and had failure to progress (21.43% compared with 7.98%; P ؍ ؍ ؍ .001). Conclusion: A history of cesarean delivery significantly elevates the risks for mother and child in future deliveries. Nonetheless, a trial of labor after previous cesarean is safe. Induction of labor, epidural anesthesia, failure to progress, and abnormal fetal heart rate pattern are all associated with failure of a trial of labor and uterine rupture.
Archives of Gynecology and Obstetrics, 2011
Purpose To determine the risk of uterine rupture for women undergoing trial of labour (TOL) with both a prior caesarean section (CS) and a vaginal delivery. Methods A systematic literature search was performed using keywords for CS and uterine rupture. The results were critically appraised and the data from relevant and valid articles were extracted. Odds ratios were calculated and a pooled estimate was determined using the Mantel-Haenszel method. Results Five studies were used for final analysis. Three studies showed a significant risk reduction for women with both a previous CS and a prior vaginal delivery (PVD) compared to women with a previous CS only, and two studies showed a trend towards risk reduction. The absolute risk of uterine rupture with a prior vaginal delivery varied from 0.17 to 0.46%. The overall odds ratio for PVD was 0.39 (95% CI 0.29-0.52, P \ 0.00001). Conclusion Women with a history of both a CS and vaginal delivery are at decreased risk of uterine rupture when undergoing TOL compared with women who have only had a CS.
Risk of Uterine Rupture during Labor among Women with a Prior Cesarean Delivery
The New England Journal of Medicine, 2001
Background Each year in the United States, approximately 60 percent of women with a prior cesarean delivery who become pregnant again attempt labor. Concern persists that a trial of labor may increase the risk of uterine rupture, an uncommon but serious obstetrical complication. Methods We conducted a population-based, retrospective cohort analysis using data from all primiparous women who gave birth to live singleton infants by cesarean section in civilian hospitals in Washington State from 1987 through 1996 and who delivered a second singleton child during the same period (a total of 20,095 women). We assessed the risk of uterine rupture for deliveries with spontaneous onset of labor, those with labor induced by prostaglandins, and those in which labor was induced by other means; these three groups of deliveries were compared with repeated cesarean delivery without labor. Results Uterine rupture occurred at a rate of 1.6 per 1000 among women with repeated cesarean delivery without labor (11 women), 5.2 per 1000 among women with spontaneous onset of labor (56 women), 7.7 per 1000 among women whose labor was induced without prostaglandins (15 women), and 24.5 per 1000 among women with prostaglandin-induced labor (9 women). As compared with the risk in women with repeated cesarean delivery without labor, uterine rupture was more likely among women with spontaneous onset of labor (relative risk, 3.3; 95 percent confidence interval, 1.8 to 6.0), induction of labor without prostaglandins (relative risk, 4.9; 95 percent confidence interval, 2.4 to 9.7), and induction with prostaglandins (relative risk, 15.6; 95 percent confidence interval, 8.1 to 30.0). Conclusions For women with one prior cesarean delivery, the risk of uterine rupture is higher among those whose labor is induced than among those with repeated cesarean delivery without labor. Labor induced with a prostaglandin confers the highest risk.