Department of Clinical Science and Education Karolinska Institute, Women's Clinic, Sodersjukhuset, Sweden.
Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
PLoS One. 2018 Jul 2;13(7):e0200024. doi: 10.1371/journal.pone.0200024. eCollection 2018.
Uterine rupture is a well-known but unusual complication in vaginal deliveries with a Cesarean section in the history. The risk of uterine rupture is at least two-fold when labor is induced. In Sweden, women are allowed to deliver vaginally after one previous Cesarean section, regardless if labor starts spontaneously or is induced. The aim of the study is to compare the proportion of uterine ruptures between the three methods (balloon catheter, Minprostin® and Cytotec®) for induction of labor in women with an unfavorable cervix and one previous Cesarean section.
Retrospective cohort study of all women with one previous Cesarean section and induction of labor with an unfavorable cervix at the four largest clinics in Stockholm during 2012-2015. Inclusion criteria: Women with a previous Cesarean section and induction of labor with a viable fetus, cephalic presentation, singleton, at ≥34 w, (n = 910).
3.0% (27/910) of the women with induction of labor had a uterine rupture, 91% of them had no previous vaginal delivery. The proportion of uterine ruptures was 2.0% (6/295) with orally administrated Cytotec®, 2.1% (7/335) with balloon catheter and 5.0% (14/ 281) when Minprostin® was used.
No difference in the proportion of uterine ruptures was shown when orally administrated Cytotec® and balloon catheter were compared (p = 0.64). Orally administrated Cytotec® and balloon catheter give a high success rate of vaginal deliveries (almost 70%) despite an unfavorable cervix.
子宫破裂是一种已知但不常见的并发症，在有剖宫产史的阴道分娩中。当诱导分娩时，子宫破裂的风险至少增加两倍。在瑞典，无论分娩是自发开始还是诱导开始，只要有一次剖宫产史，女性就可以阴道分娩。本研究的目的是比较三种方法（球囊导管、Minprostin®和Cytotec®）用于宫颈条件不佳且有一次剖宫产史的孕妇引产时子宫破裂的比例。
对 2012 年至 2015 年斯德哥尔摩四家最大诊所所有有一次剖宫产史且宫颈条件不佳行引产的妇女进行回顾性队列研究。纳入标准：有一次剖宫产史且宫颈条件不佳、有存活胎儿、头位、单胎、≥34 周的孕妇（n=910）。
910 例行引产的孕妇中，3.0%（27/910）发生子宫破裂，91%的孕妇无阴道分娩史。口服 Cytotec®组子宫破裂的比例为 2.0%（6/295），球囊导管组为 2.1%（7/335），Minprostin®组为 5.0%（14/281）。
口服 Cytotec®与球囊导管比较，子宫破裂的比例无差异（p=0.64）。尽管宫颈条件不佳，口服 Cytotec®和球囊导管仍能使阴道分娩成功率较高（近 70%）。
