Outcomes of induction of labor after one prior cesarean.
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.
Grobman
William A
WA
Departments of Obstetrics and Gynecology at Northwestern University, 333 East Superior Street, Chicago, IL 60611, USA.
Gilbert
Sharon
S
Landon
Mark B
MB
Spong
Catherine Y
CY
Leveno
Kenneth J
KJ
Rouse
Dwight J
DJ
Varner
Michael W
MW
Moawad
Atef H
AH
Caritis
Steve N
SN
Harper
Margaret
M
Wapner
Ronald J
RJ
Sorokin
Yoram
Y
Miodovnik
Menachem
M
Carpenter
Marshall
M
O'Sullivan
Mary J
MJ
Sibai
Baha M
BM
Langer
Oded
O
Thorp
John M
JM
Ramin
Susan M
SM
Mercer
Brian M
BM
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