title: Outcomes of induction of labor after one prior cesarean.
abstract: OBJECTIVE
  To compare pregnancy outcomes in women with one prior low-transverse cesarean delivery after induction of labor with pregnancy outcomes after spontaneous labor.
  
  
  METHODS
  This study is an analysis of women with one prior low-transverse cesarean and a singleton gestation who underwent a trial of labor and who were enrolled in a 4-year prospective observational study. Pregnancy outcomes were evaluated according to whether a woman underwent spontaneous labor or labor induction.
  
  
  RESULTS
  Among the 11,778 women studied, vaginal delivery was less likely after induction of labor both in women without and with a prior vaginal delivery (51% versus 65%, P<.001; and 83% versus 88%, P<.001). An increased risk of uterine rupture after labor induction was found only in women with no prior vaginal delivery (1.5% versus 0.8%, P=.02; and 0.6% versus 0.4%, P=.42). Blood transfusion, venous thromboembolism, and hysterectomy were also more common with induction among women without a prior vaginal delivery. No measure of perinatal morbidity was associated with labor induction. An unfavorable cervix at labor induction was not associated with any adverse outcomes except an increased risk of cesarean delivery.
  
  
  CONCLUSIONS
  Induction of labor in the study population is associated with an increased risk of cesarean delivery in all women with an unfavorable cervix, a statistically significant, albeit clinically small, increase in maternal morbidity in women with no prior vaginal delivery, and no appreciable increase in perinatal morbidity.
  
  
  METHODS
  II.
authors.affiliation: Departments of Obstetrics and Gynecology at Northwestern University, 333 East Superior Street, Chicago, IL 60611, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
authors.forename: Sharon
authors.initials: S
authors.lastname: Gilbert
authors.forename: Mark B
authors.initials: MB
authors.lastname: Landon
authors.forename: Catherine Y
authors.initials: CY
authors.lastname: Spong
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Leveno
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
authors.forename: Atef H
authors.initials: AH
authors.lastname: Moawad
authors.forename: Steve N
authors.initials: SN
authors.lastname: Caritis
authors.forename: Margaret
authors.initials: M
authors.lastname: Harper
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.forename: Yoram
authors.initials: Y
authors.lastname: Sorokin
authors.forename: Menachem
authors.initials: M
authors.lastname: Miodovnik
authors.forename: Marshall
authors.initials: M
authors.lastname: Carpenter
authors.forename: Mary J
authors.initials: MJ
authors.lastname: O'Sullivan
authors.forename: Baha M
authors.initials: BM
authors.lastname: Sibai
authors.forename: Oded
authors.initials: O
authors.lastname: Langer
authors.forename: John M
authors.initials: JM
authors.lastname: Thorp
authors.forename: Susan M
authors.initials: SM
authors.lastname: Ramin
authors.forename: Brian M
authors.initials: BM
authors.lastname: Mercer
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007751:Labor, Induced; D007743:Labor, Obstetric; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D017584:Reproductive History; D016064:Vaginal Birth after Cesarean