PREINDUCTION PROSTAGLANDIN E(2) GEL PRIOR TO INDUCTION OF LABOR IN WOMEN WITH A PREVIOUS CESAREAN-SECTION

The objective of the study was to evaluate the efficacy and safety of preinduction cervical ripening with 0.5 mg of intracervical prostaglan din E(2) (PGE(2)) gel in women with a previous cesarean section. A ret rospective cohort study design was used to compare 117 women with one previous cesarean section (VBACS) with 354 nulliparas. Both groups rec eived preinduction cervical ripening treatment with intracervical PGE( 2) gel. Student's t and chi(2) tests were used to evaluate group diffe rences. Mantel-Haenszel summary risk ratios and 95% confidence interva ls were examined in order to assess the relative risk of cesarian sect ion delivery after adjusting for potential confounders. The mean numbe rs of PGE(2) gel applications were 2.4 and 2.5 for VBACS and controls, respectively (p > 0.05). Thirty-nine percent of VBACS entered labor s pontaneously as compared with 33% of nulliparas. Mean duration of rupt ured membranes (8.2 vs. 12.1 h) and length of labor (20.1 vs. 28.5 h) were reduced among VBACS as compared with controls (p < 0.05). Overall , VBACS had a higher cesarean section rate as compared with controls ( 49.6 vs. 31.9%; adjusted relative risk = 1.6, 95% confidence interval 1.2-2.1). There were no differences in the occurrence of maternal and fetal morbidity. Overall, the efficacy and safety of 0.5 mg PGE(2) gel administered for preinduction cervical ripening in VBACS is comparabl e to that observed in nulliparas.