Experience of birth induction in women with a scuber on the uterus after cesara section

• Yulia D. Vuchenovich
• Vladislavа A. Novikovа
• Igor N. Kostin

Abstract

The aim of this study - to evaluate the effectiveness of induction/pre-induction of labor in women with a cesarean scar.

Material and methods. A prospective cohort study conducted (2013-2019, Moscow). 210 patients with a uterine scar after one cesarean section (CS) with trial of vaginal labor were selected: 60 patients underwent induction/pre-induction of labor, 150 developed spontaneous labour.

Results. The induction/pre-induction of labor in women with a uterine scar after cesarean section is effective (66.67%), not associated with the risk of intrapartum CS compared with their spontaneous onset of labor [RR=0.09 (95% CI 0.02-0.33)]. Indication for intranatal CS in both groups was the weakness of labor. The likelihood of internal CS determines the interval between the transferred CS and the actual pregnancy, pre-gestational BMI. The thickness of the uterine scar is not associated with the risk of intrapartum CS.

Conclusion. Induction/pre-induction of Labor, as an option of a trial of vaginal Labor after cesarean, is a measure to reduce the frequency of re-CS, but the criteria justifying the choice of delivery method, and the subsequent risks, require a rigorous assessment of anamnestic, anthropometric, gestational clinical, ultrasound and other criteria and their combination.

Keywords:labor induction, labor pre-induction, cesarean section, trial of vaginal labor after cesarean, uterine scar after cesarean section

References

1. Radzinsky V.E. Obstetric aggression, v. 2.0. Moscow: StatusPraesens, 2017: 872 p. (in Russian)

2. ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery. Obstet Gynecol. 2019; 133 (2): e110-27. doi: 10.1097/AOG.0000000000003078.

3. Clinical recommendations (treatment protocol) “Caesarean section. Indications, methods of analgesia, surgical technique, antibiotic prophylaxis, postoperative management Moscow, 2014: 44 p. (in Russian)

4. Spontaneous delivery of patients with a scar on the uterus after cesarean section. Clinical protocol. Akusherstvo i ginekologiya [Obstetrics and Gynecology]. 2016; (12): 12-9. (in Russian)

5. Medical preparation of the cervix for childbirth and childbirth. Clinical recommendations. Moscow, 2015. URL: http://zdravorel.ru/arhiv/ncagip21.pdf. (in Russian)

6. Wallstrom T., Bjorklund J., Frykman J., Jarnbert-Pettersson H., et al. Induction of labor after one previous Cesarean section in women with an unfavorable cervix: A retrospective cohort study. PLoS One. 2018; 13 (7): e0200024. doi: 10.1371/journal.pone.0200024. eCollection 2018.

7. Thisted D.L.A., Mortensen L.H., Hvidman L., Krebs L. Operative technique at caesarean delivery and risk of complete uterine rupture in a subsequent trial of labour at term. A registry case-control study. PLoS One. 2017; 12 (11): e0187850. doi: 10.1371/journal.pone.0187850. eCollection 2017.

8. Place K., Kruit H., Tekay A., Heinonen S., Rahkonen L. Success of trial of labor in women with a history of previous cesarean section for failed labor induction or labor dystocia: a retrospective cohort study. BMC Pregnancy Childb. 2019; 19 (1): 176. doi: 10.1186/s12884-019-2334-3.

9. Viteri O.A., Sibai B.M. Challenges and limitations of clinical trials on labor induction: a review of the literature. AJP Rep. 2018; 8 (4): e365-78. doi: 10.1055/s-0038-1676577. Epub 2018 Dec 26.

10. de Vaan M.D., Ten Eikelder M.L., Jozwiak M., Palmer K.R., et al. Mechanical methods for induction of labour. Cochrane Database Syst Rev. 2019; 10: CD001233. doi: 10.1002/14651858.CD001233.pub3. [Epub ahead of print].

11. West H.M., Jozwiak M., Dodd J.M. Methods of term labour induction for women with a previous caesarean section. Cochrane Database Syst Rev. 2017; 6: CD009792. doi: 10.1002/14651858.CD009792.pub3

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