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Methods of term labour induction for women with a previous caesarean section


Jozwiak, M. and Dodd, J.M.

Subject Keywords: Labour induction, Women, Caesarean birth, Pregnancy
Type: Article
Region: International (other)

Worldwide, caesarean birth is common, with percentages ranging from 25% to 50% of reported births. Current clinical practice guidelines support vaginal birth and trial of labour among women who have had a previous caesarean birth. Women with a prior caesarean birth have an increased risk of uterine scar rupture, particularly when labour is induced. This is a serious complication, often leading to negative outcomes for mother and child, such as hysterectomy, genitourinary tract injury, and postpartum blood transfusions for the mother, and neurological impairment or even death for the child. Labour induction is a common obstetric procedure that is carried out when the risk of continuing pregnancy outweighs the benefits. Methods include: prostaglandin medication (including oral or vaginal prostaglandins E2 (PGE2) or misoprostol); mifepristone; mechanical methods (including Foley catheters and double balloon catheters); and oxytocin. The goal of this review was to assess the harms and benefits of different methods of induction of labour in women with a prior caesarean birth, should induction of labour be required in their present pregnancy.

Two randomised controlled studies (involving 80 women in their third trimester) met our inclusion criteria. The studies used different methods of inducing labour, vaginal PGE2 inserts versus oxytocin, and misoprostol versus oxytocin.. Comparing PGE2 to oxytocins, no differences were found in the risk of caesarean section, nor other primary or secondary outcomes, of which only instrumental vaginal deliveries, epidural analgesia, Apgar score, perinatal death were reported. One uterine rupture was reported in the PGE2 group. The second study compared misoprostol to oxytocin. This study was stopped prematurely after the inclusion of 38 women because of the occurrence of two uterine ruptures in the misoprostol group. This study did not report on other outcomes than uterine rupture. Risk of bias in the included studies was judged as low or unclear. They were underpowered to detect clinically relevant differences in the outcomes measured.



Rights: © The Cochrane Collaboration
Suggested citation:

Jozwiak, M. and Dodd, J.M.. (2013) Methods of term labour induction for women with a previous caesarean section [Online]. Available from: [Accessed: 23rd August 2019].


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