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. 2023 Feb 12;11(4):543.
doi: 10.3390/healthcare11040543.

Induction of Labor in Women with Previous Cesarean Section and Unfavorable Cervix: A Retrospective Cohort Study

Chiara Germano  1   2 , Ilenia Mappa  3 , Antonella Cromi  4 , Enrico Busato  5 , Maddalena Incerti  6 , Andrea Lojacono  7 , Giuseppe Rizzo  8 , Rossella Attini  1 , Lodovico Patrizi  8 , Alberto Revelli  1 , Bianca Masturzo  2
Affiliations

Induction of Labor in Women with Previous Cesarean Section and Unfavorable Cervix: A Retrospective Cohort Study

Chiara Germano et al. Healthcare (Basel). .

Abstract

Background: The efficacy and safety of a cervical ripening balloon (CRB) in women with a previous cesarean section (CS) and unfavorable Bishop score are still controversial. Methods: A retrospective cohort study was performed across six tertiary hospitals from 2015 to 2019. Women with one previous transverse CS, singleton cephalic term pregnancy and BS < 6 were included if submitted to labor induction with a CRB. The main outcome was the rate of vaginal birth after cesarean (VBAC) after CRB ripening. Secondary outcomes were abnormal composite fetal and maternal outcomes. Results: Of the 265 women included, 57.3% had successful vaginal birth. Augmentation improved vaginal delivery (32.2% vs. 21.2%). Intrapartum analgesia was associated with an increased VBAC rate (58.6% vs. 34.5%). Maternal BMI ≥30 and age ≥40 years increased emergency CS rate (11.8% vs. 28.3% and 7.2 vs. 15.9%). Composite adverse maternal outcome occurred in 4.8% of CRB group women and increased to 17.6% when associated with oxytocin. Uterine rupture occurred in one case (0.4%) in the CRB-oxytocin group. Poorer fetal outcome occurred after emergency CS, if compared to successful VBAC (12.4% vs. 3.3%). Conclusions: In women with a previous CS and unfavorable Bishop score, induction of labor with a CRB can be considered safe and effective.

Keywords: cervical ripening balloon; cesarean section; trial of labor after cesarean section; unfavorable cervix.

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Conflict of interest statement

The authors declare that they have no relevant financial or non-financial interest to disclose, no conflict of interest to declare that are relevant to the content of this article, no affiliations with, or involvement in, any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript, and no financial or proprietary interests in any material discussed in this article.

Figures

Figure 1
Figure 1
STROBE flow chart. CS: cesarean section.
See this image and copyright information in PMC

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