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Obstetrics & Gynecology 2007;109:262-269
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Outcomes of Induction of Labor After One Prior Cesarean

William A. Grobman, MD, MBA1, Sharon Gilbert, MS, MBA2, Mark B. Landon, MD3, Catherine Y. Spong, MD4, Kenneth J. Leveno, MD5, Dwight J. Rouse, MD6, Michael W. Varner, MD7, Atef H. Moawad, MD8, Steve N. Caritis, MD9, Margaret Harper, MD10, Ronald J. Wapner, MD11, Yoram Sorokin, MD12, Menachem Miodovnik, MD12,14, Marshall Carpenter, MD15, Mary J. O’Sullivan, MD16, Baha M. Sibai, MD17, Oded Langer, MD18, John M. Thorp, MD19, Susan M. Ramin, MD20, Brian M. Mercer, MD21 for the National Institute of Child Heath and Human Development Maternal–Fetal Medicine Units Network*

From the Departments of Obstetrics and Gynecology at 1Northwestern University, Chicago, Illinois; 3the Ohio State University, Columbus, Ohio; 5University of Texas Southwestern Medical Center, Dallas, Texa; 6University of Alabama at Birmingham, Birmingham, Alabama; 7University of Utah, Salt Lake City, Utah; 8University of Chicago, Chicago, Illinois; 9University of Pittsburgh, Pittsburgh, Pennsylvania; 10Wake Forest University, Winston-Salem, North Carolina; 11Thomas Jefferson University, Philadelphia, Pennsylvania; 12Wayne State University, Detroit, Michigan; 13University of Cincinnati, Cincinnati, Ohio; 14Columbia University, New York, New York; 15Brown University, Providence, Rhode Island; 16University of Miami, Miami, Florida; 17University of Tennessee, Memphis, Tennessee; 18University of Texas at San Antonio, San Antonio, Texas; 19University of North Carolina, Chapel Hill, North Carolina; 20University of Texas at Houston, Houston, Texas; 21Case Western Reserve University, Cleveland, Ohio; and the 2George Washington University Biostatistics Center, Washington, DC, and the 4National Institute of Child Health and Human Development, Bethesda, Maryland.

OBJECTIVE: To compare pregnancy outcomes in women with one prior low-transverse cesarean delivery after induction of labor with pregnancy outcomes after spontaneous labor.

METHODS: 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.

RESULTS: 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.

CONCLUSION: Induction of labor in the study population is associated with an increased risk of cesarean delivery in all women with an unfavorable cervix, a statistically significant, albeit clinically small, increase in maternal morbidity in women with no prior vaginal delivery, and no appreciable increase in perinatal morbidity.

LEVEL OF EVIDENCE: II






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