title: Safety of low-dose prostaglandin E2 induction in grandmultiparous women with previous cesarean delivery.
abstract: OBJECTIVE
  To determine the safety and efficacy of labor induction with low-dose vaginal prostaglandin E2 (PGE2) in grandmultiparous women with a previous cesarean delivery.
  
  
  METHODS
  We conducted a retrospective cohort study of 219 grandmultiparous women with a previous cesarean delivery (study group) who underwent induction of labor with low dose PGE2. These patients were compared to 1376 grandmultiparous women without a previous cesarean section (control group) who underwent induction of labor with low dose PGE2. The primary outcome was uterine rupture and secondary outcomes included mode of delivery, post-partum hemorrhage (PPH) and a low 5-min Apgar score (≤7).
  
  
  RESULTS
  One patient in the study group as well as one patient in the control group were diagnosed with uterine rupture (0.4% versus 0.07%). In the study group, vaginal delivery was achieved in 204 (93.16%) patients, whereas 15 (6.84%) patients had emergent cesarean delivery. Five minutes Apgar score ≤7 was recorded in two cases (0.9%) in the study group. Patients in the study group had a significantly higher rate of cesarean delivery (6.84%, versus 3.4%, respectively, p < 0.001) as well as operative vaginal delivery (4.56% versus 2% respectively, p < 0.05) compared to the control group. There were no significant differences between the groups regarding the rate of PPH (0.91% versus 0.90%, p = 0.2) or 5-min Apgar score ≤7 (0.91% versus 0.22%, p = 0.28).
  
  
  CONCLUSIONS
  Low dose PGE2 is a relative safe method for induction of labor in grandmultiparous women with a previous cesarean section.
authors.affiliation: Mayanei-Hayeshua medical center , Bnei-Brak , Israel and.
authors.forename: Jigal
authors.initials: J
authors.lastname: Haas
authors.forename: Eran
authors.initials: E
authors.lastname: Barzilay
authors.forename: Benny
authors.initials: B
authors.lastname: Chayen
authors.forename: Oshrit
authors.initials: O
authors.lastname: Lebovitz
authors.forename: Yoav
authors.initials: Y
authors.lastname: Yinon
authors.forename: Shali
authors.initials: S
authors.lastname: Mazaki-Tovi
authors.forename: Linda
authors.initials: L
authors.lastname: Harel
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D016022:Case-Control Studies; D015232:Dinoprostone / Q000008:administration & dosage* / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects*; D010298:Parity / Q000187:drug effects; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014597:Uterine Rupture / Q000453:epidemiology; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data
chemical_list: D010120:Oxytocics; D015232:Dinoprostone