title: Double-balloon catheter and sequential vaginal prostaglandin E2 versus vaginal prostaglandin E2 alone for induction of labor after previous cesarean section.
abstract: OBJECTIVE
  To evaluate the efficacy of inducing labor using a double-balloon catheter and vaginal prostaglandin E2 (PGE2) sequentially, in comparison with vaginal PGE2 alone after previous cesarean section.
  
  
  METHODS
  A total of 264 pregnant women with previous cesarean section undergoing labor induction at term were included in this prospective multicentre cohort study. Induction of labor was performed either by vaginal PGE2 gel or double-balloon catheter followed by vaginal PGE2. The primary outcome measure was the cesarean section rate.
  
  
  RESULTS
  The cesarean section rate was 37 % without any statistically significant difference between the two groups (PGE2: n = 41, 37 % vs. balloon catheter/PGE2: n = 41, 42 %; P = 0.438). The median (range) number of applications of PGE2 [2 (1-10) versus 1 (0-8), P < 0.001] and the total amount of PGE2 used in median (range) mg [2 (1-15) vs. 1 (0-14), P = 0.001] was less in the balloon catheter/PGE2 group. Factors significantly increasing risk for cesarean section were "no previous vaginal delivery" (OR 5.391; CI 2.671-10.882) and "no oxytocin augmentation during childbirth" (OR 2.119; CI 1.215-3.695).
  
  
  CONCLUSIONS
  The sequential application of double-balloon catheter and vaginal PGE2 is as effective as the sole use of vaginal PGE2 with less applications and total amount of PGE2.
authors.affiliation: Department of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstraße 21-23, 91054, Erlangen, Germany. sven.kehl@gmail.com.|Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany. sven.kehl@gmail.com.
authors.forename: Sven
authors.initials: S
authors.lastname: Kehl
authors.affiliation: Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany.
authors.forename: Christel
authors.initials: C
authors.lastname: Weiss
authors.affiliation: Department of Obstetrics and Gynecology, Hospital Memmingen, Memmingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Wamsler
authors.affiliation: Department of Obstetrics, Jena University Hospital, Jena, Germany.
authors.forename: Jana
authors.initials: J
authors.lastname: Beyer
authors.affiliation: Department of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstraße 21-23, 91054, Erlangen, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Dammer
authors.affiliation: Department of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstraße 21-23, 91054, Erlangen, Germany.
authors.forename: Jutta
authors.initials: J
authors.lastname: Heimrich
authors.affiliation: Department of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstraße 21-23, 91054, Erlangen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Faschingbauer
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Sütterlin
authors.affiliation: Department of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstraße 21-23, 91054, Erlangen, Germany.
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Beckmann
authors.affiliation: Department of Obstetrics, Jena University Hospital, Jena, Germany.
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Schleussner
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D002404:Catheterization / Q000379:methods*; D057785:Catheters / Q000009:adverse effects; D002584:Cervix Uteri / Q000187:drug effects; D002585:Cesarean Section / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric; D015232:Dinoprostone / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000295:instrumentation / Q000379:methods*; D007743:Labor, Obstetric / Q000187:drug effects; D010120:Oxytocics / Q000008:administration & dosage; D010121:Oxytocin / Q000008:administration & dosage*; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome; D016064:Vaginal Birth after Cesarean / Q000295:instrumentation / Q000706:statistics & numerical data*
chemical_list: D010120:Oxytocics; D010121:Oxytocin; D015232:Dinoprostone
keywords: Dinoprostone; Double-balloon catheter; Induction of labor; Previous cesarean section; Prostaglandin E2; Scarred uterus