Uterine rupture with the use of PGE2 vaginal inserts for labor induction in women with previous cesarean sections.
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.
Taylor
Donald R
DR
Department of Maternal-Fetal Medicine, St. Alexius Hospital, Hoffman Estates, Illinois, USA.
Doughty
Andrea S
AS
Kaufman
Howard
H
Yang
Lee
L
Iannucci
Thomas A
TA
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
D010120:Oxytocics; D015232:Dinoprostone