title: Cervical ripening with low-dose prostaglandins in planned vaginal birth after cesarean.
abstract: OBJECTIVE
  To compare uterine rupture, maternal and perinatal morbidity rates in women with one single previous cesarean after spontaneous onset of labor or low-dose prostaglandin-induced cervical ripening for unfavourable cervix.
  
  
  METHODS
  This was a retrospective cohort study of 4,137 women with one single previous cesarean over a 22-year period. Inpatient prostaglandin administration consisted in single daily local applications.
  
  
  RESULTS
  Vaginal delivery was planned for 3,544 (85.7%) patients, 2,704 (76.3%) of whom delivered vaginally (vaginal birth after Cesarean (VBAC) rate = 65.4%). Among women receiving prostaglandins (n=515), 323 (62.7%) delivered vaginally. Uterine rupture (0.7% compared with 0.8%, OR 1.1, 95% CI 0.4-3.4, p=0.88), maternal (0.9% compared with 1.2%, OR 1.3, 95% CI 0.5-3.2, p=0.63) and perinatal (0.3% compared with 0.8%, OR 2.4, 95% CI 0.7-8.5, p=0.18) morbidity rates did not differ significantly between patients with spontaneous onset of labor and those receiving prostaglandins, nor did these rates differ according to the planned mode of delivery.
  
  
  CONCLUSIONS
  In comparison with patients with spontaneous labor, inducing cervical ripening with low-dose prostaglandins in case of unfavourable cervix is not associated with appreciable increase in uterine rupture, maternal or perinatal morbidity.
authors.affiliation: Service de Gynécologie Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France ; Université Paris Diderot, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmitz
authors.forename: Anne-Gaelle
authors.initials: AG
authors.lastname: Pourcelot
authors.forename: Constance
authors.initials: C
authors.lastname: Moutafoff
authors.forename: Valérie
authors.initials: V
authors.lastname: Biran
authors.forename: Olivier
authors.initials: O
authors.lastname: Sibony
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Oury
mesh_terms: D000328:Adult; D020070:Cervical Ripening / Q000187:drug effects*; D002584:Cervix Uteri / Q000187:drug effects; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D010120:Oxytocics; D011247:Pregnancy; D011453:Prostaglandins; D012189:Retrospective Studies; D014219:Trial of Labor; D014597:Uterine Rupture / Q000517:prevention & control*; D016064:Vaginal Birth after Cesarean
chemical_list: D010120:Oxytocics; D011453:Prostaglandins