CERVICAL RIPENING IN WOMEN WITH PREVIOUS CESAREAN DELIVERIES

Objective: To evaluate the safety and efficacy of preinduction cervica l ripening in women with previous cesarean deliveries undergoing induc tion of labor. Methods: Retrospective study of women with previous low transverse cesarean deliveries who underwent ripening of an unfavorab le cervix prior to induction of labor (n = 89). Multiparas without pre vious cesarean deliveries undergoing ripening and induction of labor d uring the same time period were used for comparison (n = 61). Ripening was performed with prostaglandin E(2)? (PGE(2)) gel, or an osmotic di lator, or both. Induction of labor with oxytocin followed the American College of Obstetricians and Gynecologists' guidelines. Outcome data were analyzed using the unpaired Student's t-test or x(2)-test as appr opriate. Significance was established at P < 0.05. Results: The mean g estational age was 39.6 +/- 2.6 and 38.2 +/- 2.9 weeks for the study a nd comparison groups, respectively. There were no differences between the groups in Bishop score, duration of the first stage of labor, maxi mum dose of oxytocin, indications for cesarean delivery, puerperal mor bidity, birthweight, Apgar scores or NICU admissions. Sixty-four perce nt (57 of 89) of study women delivered vaginally compared with 82% (50 of 61) of women in the comparison group (P < 0.03). The data were ana lyzed separately for those women undergoing cervical ripening with PGE (2) gel only. No differences were observed between the groups in any o f the categories mentioned above. Conclusion: Cervical ripening appear s to be safe and effective in women with previous low transverse cesar ean deliveries undergoing induction of labor with an unfavorable cervi x.