Date: 04 Jun 2014

Efficacy and safety of labour induction in patients with a single previous Caesarean section: a proposal for a clinical protocol

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Abstract

Purpose

To evaluate the efficacy and safety of induction in women with a single prior Caesarean section.

Methods

This was a cohort study in which we included all singleton pregnancies in patients with a single prior Caesarean who delivered between 2007 and 2012. Methods of induction were ocytocic infusion plus amniotomy (if Bishop score ≥6) or insertion of a Foley catheter (Bishop <6).

Results

Of the 2,075 patients included, 806 (38.8 %) had an elective repeat Caesarean, 1,045 (50.4 %) went into spontaneous labour, 89 (4.3 %) were induced by artificial rupture of the membranes and infusion of ocytocics and 135 (6.5 %) were induced using a Foley catheter. Rates of vaginal delivery were 79.2, 79.8 and 43.7 %, respectively. Six cases of uterine rupture were reported in the group of patients who went into spontaneous labour. There was no difference between groups with regard to neonatal morbidity. On multivariate analysis, risk factors for Caesarean delivery were macrosomia (OR 2.04, 95 % CI 1.31–3.18) and induction by Foley catheter (OR 3.73, 95 % CI 2.47–5.62); protective factors were previous vaginal delivery (OR 0.41, 95 % CI 0.29–0.57) and cervical dilatation (OR 0.84, 95 % CI 0.78–0.91).

Conclusions

Uterine induction after a single Caesarean section with ocytocic infusion and amniotomy where the cervix is favourable does not appear to entail any significant added risk in terms of maternal or foetal morbidity. Foley catheter induction is a reasonable option if the cervix is not ripe.