Clinical Health Updates

Induction of labor after one prior cesarean is relatively safe

Clinical Question:
Does induction of labor increase the risk of uterine rupture in women with one prior cesarean section?

Bottom Line:
For women with one prior cesarean delivery and no prior vaginal delivery, induction of labor results in an absolute increase in the risk of uterine rupture of 0.7% compared with spontaneous delivery. No significant difference was seen between induced labor or spontaneous labor in women with one prior cesarean delivery and at least one prior vaginal delivery. Perinatal morbidity was not associated with labor induction. Since these are observational data, a randomized controlled trial is still needed to definitively settle the question.

Reference:
Grobman WA, Gilbert S, Landon MB, et al. Outcomes of induction of labor after one prior cesarean. Obstet Gynecol 2007;109:262-269.

Study Design:
Cohort (prospective)

Synopsis:
The authors compared pregnancy outcomes in women with one prior low-transverse cesarean delivery after induction of labor with pregnancy outcomes after spontaneous labor. This study is an analysis of women with one prior low-transverse cesarean and a singleton gestation who underwent a trial of labor and who were enrolled in a 4-year prospective observational study. Pregnancy outcomes were evaluated according to whether a woman underwent spontaneous labor or labor induction. Among the 11,778 women studied, vaginal delivery was less likely after induction of labor both in women without and with a prior vaginal delivery (51% versus 65%, P<.001; and 83% versus 88%, P<.001). An increased risk of uterine rupture after labor induction was found only in women with no prior vaginal delivery (1.5% versus 0.8%, P=.02; and 0.6% versus 0.4%, P=.42). Blood transfusion, venous thromboembolism, and hysterectomy were also more common with induction among women without a prior vaginal delivery. No measure of perinatal morbidity was associated with labor induction. An unfavorable cervix at labor induction was not associated with any adverse outcomes except an increased risk of cesarean delivery.