Comparison of induction of labor methods for unfavorable cervices in trial of labor after cesarean delivery.
OBJECTIVE
To compare induction of labor methods in patients attempting a trial of labor after cesarean (TOLAC) with an unfavorable cervix.


METHODS
This is a retrospective cohort study from patients attempting TOLAC from 2009 to 2013. Patients with a simplified Bishop score of three or less where labor was initiated with either a Cook balloon or oxytocin were included. Our primary outcome was mode of delivery. Our secondary outcomes included duration of labor and multiple maternal and neonatal morbidities.


RESULTS
Two-hundred and fourteen women met inclusion criteria: 150 received oxytocin and 64 had the Cook balloon placed. The vaginal birth after cesarean delivery rate was significantly higher in the oxytocin group at 70.7% versus 50.0% in the Cook balloon group (p = 0.004). In the multivariable analysis, odds for cesarean delivery were two times higher with the Cook balloon than with oxytocin (Adjusted OR = 2.09, 95% CI = 1.05-4.18, p = 0.036). The duration of labor was longer with the Cook balloon versus oxytocin (21.9 versus 16.3 hours, p = 0.0002). There were no significant differences in maternal and neonatal health outcomes.


CONCLUSIONS
Oxytocin induction of labor was associated with a higher rate of vaginal delivery and a shorter duration of labor compared to the Cook balloon in women undergoing TOLAC with an unfavorable cervix.
a Department of Obstetrics and Gynecology , Baylor College of Medicine , Houston , Texas , USA.
Utsavi
U
Shah
a Department of Obstetrics and Gynecology , Baylor College of Medicine , Houston , Texas , USA.
Patricia
P
Bellows
a Department of Obstetrics and Gynecology , Baylor College of Medicine , Houston , Texas , USA.
Kathleen
K
Drexler
a Department of Obstetrics and Gynecology , Baylor College of Medicine , Houston , Texas , USA.
Lauren
L
Hawley
a Department of Obstetrics and Gynecology , Baylor College of Medicine , Houston , Texas , USA.
Christina
C
Davidson
a Department of Obstetrics and Gynecology , Baylor College of Medicine , Houston , Texas , USA.
Haleh
H
Sangi-Haghpeykar
a Department of Obstetrics and Gynecology , Baylor College of Medicine , Houston , Texas , USA.
Manisha
M
Gandhi
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D007743:Labor, Obstetric; D010120:Oxytocics; D010121:Oxytocin; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*
D010120:Oxytocics; D010121:Oxytocin
Bishop score; Cook balloon; TOLAC; VBAC; oxytocin