Induction of labor in women with a uterine scar.

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.