title: Uterine rupture with the use of PGE2 vaginal inserts for labor induction in women with previous cesarean sections.
abstract: OBJECTIVE
  To analyze the rate of uterine rupture in women with previous cesarean sections undergoing a trial of labor in which a prostaglandin E2 (PGE2) vaginal insert was used.
  
  
  METHODS
  The study was based on a computerized search and review of pharmacy records, medical records and the pertinent literature. Pharmacy records were correlated with the medical records of all women undergoing a trial of labor after cesarean section over a 33-month period.
  
  
  RESULTS
  Between January 1998 and September 2000, 13,544 patients delivered. Of these cases, 790 were vaginal trials of labor after previous cesarean section. A PGE2 vaginal insert was used in 58 of the patients. A total of 6 of these 58 patients (10.3%) experienced uterine rupture. This compares to a rupture rate of 1.1% (8/732) in deliveries not using PGE2 vaginal inserts.
  
  
  CONCLUSIONS
  The risk of uterine rupture was significantly increased in patients undergoing a trial of labor after previous cesarean section when a PGE2 vaginal insert was used. Physicians need to be aware that using a PGE2 vaginal inserts for cervical ripening and/or induction of labor in women with a previous cesarean section might increase the risk of uterine rupture above the standard risk for vaginal birth after cesarean (VBAC) candidates. We recommend that all VBAC patients using a PGE2 vaginal insert be closely monitored for evidence of uterine rupture.
authors.affiliation: Department of Maternal-Fetal Medicine, St. Alexius Hospital, Hoffman Estates, Illinois, USA.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Taylor
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Doughty
authors.forename: Howard
authors.initials: H
authors.lastname: Kaufman
authors.forename: Lee
authors.initials: L
authors.lastname: Yang
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Iannucci
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D015232:Dinoprostone / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007751:Labor, Induced; D008499:Medical Records; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects*; D011247:Pregnancy; D012189:Retrospective Studies; D014597:Uterine Rupture / Q000139:chemically induced / Q000453:epidemiology*; D016064:Vaginal Birth after Cesarean
chemical_list: D010120:Oxytocics; D015232:Dinoprostone