An audit about labour induction, using prostaglandin, in women with a scarred uterus

Induction of labour after a previous caesarean section is still controversial. We aim to analyse, in a population of women who have a uterine scar, the maternal, foetal and neonatal complications in relation to the mode of labour and delivery.

Among 798 singleton deliveries, 36.1 % had a spontaneous labour, 12.6 % a prostaglandin-induced labour and 2.9 % an ocytocin-induced labour, and 48.4 % had an elective caesarean section. The chance of delivering vaginally was respectively 84.4 % for those who had a spontaneous labour, 75.2 % for those who were induced using prostaglandin, 82.6 % after induction using ocytocin. There were eight uterine ruptures, four after spontaneous labour (1.4 %), two after prostaglandin induction (2 %) and two at the time of an iterative caesarean section (0.5 %). There were no differences between groups, except the risk of haemorrhage (17.4 % after spontaneously induced labour, 34.8 % after ocytocin, 17.8 % after prostaglandin and 44.6 % after iterative caesarean section; p < 0.005) and the neonatal admissions when analysed by intention to treat only (8.3 % after spontaneously induced labour, 9.1 % after ocytocin, 12 % after prostaglandin and 16.8 % after iterative caesarean section; p < 0.009).

Although no increase in maternal or perinatal outcome was observed in relation to prostaglandin-induced labour after caesarean section, this study is too underpowered to exclude an increased risk.