Induction of Labor with Prostaglandin E2 in Women with Previous Cesarean Section and Unfavorable Cervix

Background: Induction of labor is common in obstetric practice. According to the most current studies, the rate varies from 9.5 to 33.7 percent of all pregnancies annually. In the absence of a ripe or favorable cervix, a successful vaginal birth is less likely. Therefore, cervical ripening or preparedness for induction should be assessed before a regimen is selected. To objective is to study the pregnancy outcome of induction of labor with prostaglandin E2 (PGE2) in women with one previous lower segment cesarean section. Methods : A prospective study was conducted at Maternity & Children Hospital, Buraidah (Qassim), Saudi Arabia. The sample included 153 consecutive women with one previous cesarean section, of whom 75 underwent induction of labor (study group) and 78 were admitted with spontaneous onset of labor (control group). Vaginal tablets of PGE2 were used for cervical ripening in the study group. Mode of delivery, neonatal outcome, indications for cesarean section, and rate of uterine rupture were compared between the groups. Results : There were no significant differences between the study and control groups in mean (_S.D.) maternal age (30:9 _ 4:7 years versus 31:2 _ 4:8 years, P ¼ 0:6), gestational age at delivery (39:2 _ 1:8 weeks versus 39:3 _ 1:6 weeks, P ¼ 0:36), overall rate of cesarean section (24% versus 20.5%, P ¼ 0:8), rates of low 5-min Apgar score (3.1% versus 3.7%, P ¼ 0:67) or cesarean section performed for non-reassuring fetal heart rate (9.3% versus 7.69%, P ¼ 0:1). There were no cases of uterine rupture, in both groups. Conclusion : The findings suggest that induction of labor in women with one previous cesarean section does not increase the risk of cesarean section rate and does not adversely affect immediate neonatal outcome. We cautiously suggest that when there is no absolute indication for repeated cesarean section, induction of labor may be considered.