The benefits and risks of inducing labour in patients with prior caesarean delivery: a systematic review.
OBJECTIVE
To evaluate the risks and benefits of inducing labour in women with a prior caesarean delivery.


METHODS
Systematic review.


METHODS
Pregnant women with prior caesarean delivery.


METHODS
Studies were identified using MEDLINE, EMBASE, HealthSTAR, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effectiveness, reference lists and experts.


METHODS
All studies reporting data for outcomes in women with induced labours and prior caesarean were eligible. Methodologic quality was evaluated using the criteria of the U.S. Preventive Services Task Force and the NHS Centre for Reviews and Dissemination. We assigned studies good, fair or poor rating.


RESULTS
We reviewed 162 full text articles, identified 14 fair-quality studies, and found no good-quality studies. Compared with spontaneous labour, induction was more likely to result in caesarean delivery. Of women undergoing spontaneous labour, 20% had a caesarean (range 11-35%) compared with 32% receiving oxytocin (range 18-44%). In studies of PGE2, spontaneous labour resulted in caesarean delivery in 24% (range 18-51%) compared with 48% with PGE2 (range 28-51%). There was a non-significant increase in uterine ruptures among those induced compared with spontaneous labours. There were no maternal deaths; other maternal complications were infrequently reported. Only four studies reported on infant deaths; other infant outcomes were inadequately reported.


CONCLUSIONS
Women with a history of caesarean attempting trial of labour who require induction have a higher rate of caesarean delivery and have a slightly elevated risk of rupture compared with similar women with spontaneous labour. More consideration is needed for potential confounders: dose, reasons for induction and appropriate comparison groups.
McDonagh
Marian S
MS
Department of Medical Informatics and Clinical Epidemiology and the Evidence-Based Practice Center, Oregon Health and Science University, Portland, Oregon, USA.
Osterweil
Patricia
P
Guise
Jeanne-Marie
JM
D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data; D002986:Clinical Trials as Topic / Q000592:standards; D015232:Dinoprostone; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D010120:Oxytocics; D010121:Oxytocin; D011247:Pregnancy; D011256:Pregnancy Outcome; D012107:Research Design / Q000592:standards; D012307:Risk Factors; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data
D010120:Oxytocics; D010121:Oxytocin; D015232:Dinoprostone