Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 15 , ISSUE 5 ( September-October, 2023 ) > List of Articles


A Comparison of Different Methods of Induction of Labor in Patients of Previous Cesarean Section

Divya Yadav Sharma, Ruchika Garg, Rachana Agarwal, Abhilasha Yadav

Keywords : Bishop score, Foley catheter, Intrauterine death, Mifepristone, Previous caesarian section, Prostaglandin E-2, Preinduction cervical ripening, Scarred uterus, Scar tenderness, Trial of labor

Citation Information : Sharma DY, Garg R, Agarwal R, Yadav A. A Comparison of Different Methods of Induction of Labor in Patients of Previous Cesarean Section. J South Asian Feder Obs Gynae 2023; 15 (5):580-584.

DOI: 10.5005/jp-journals-10006-2287

License: CC BY-NC 4.0

Published Online: 31-10-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Introduction: The alarming rise of cesarean deliveries in the past decades has even questioned the ethics of the medical fraternity. This study was conducted to reduce the burden of morbidities associated with repeat cesarean deliveries. In this study, we compared the safety and efficacy of different methods of induction of labor (IOL) in cases with previous one cesarean section. Materials and methods: After following strict exclusion criteria, 78 patients were found to be eligible to participate in the study. After history, examination and investigations, and USG, patients were assigned to any one of the methods for the IOL. (PGE2 group) (n = 31). Patients with Bishops score >4, with cervical dilatation >1.5 cm, middle/anterior position of cervix, were 31 in number. For these patients, Prostaglandin E2 (PGE2) gel was inserted in the posterior fornix. PGE2+ Foley catheter (n = 22). In some patients with similar Bishops score, after instillation of PGE2, intracervical Foley catheter was inserted and inflated with 30 mL saline. Patients with intrauterine death of fetus, or multiple congenital malformations were diagnosed on USG, 200 mg of Mifepristone was administered orally, followed by PGE2 gel after 8 hours (Mifepristone + Foley + PGE2 (n = 12) Similarly, in 12 patients with intrauterine death/multiple congenital malformations, after 8 hours of 200 mg of Mifepristone, intracervical foley catheter balloon and PGE2 were instilled in post-fornix. In all cases, oxytocin augmentation was done with an infusion set as per protocol. Labor was immediately terminated by performing immediate cesarean in the following circumstances. Severe maternal distress, severe fetal distress, non-progress of labor, signs of impending scar dehiscence. Results: We observed an overall success rate of TOLAC as 68% by various methods of induction. Maximum success was observed in group D by using mifepristone along with PGE2 and Foleys, in which fetal prognosis was not desired. Our greatest predictor of success was a previous vaginal delivery (Odds Ratio, OR = 24.4), followed by initial Bishops score >5, (OR = 20.3), and BMI <28 (OR = 5.3). We encountered a scar dehiscence rate of 2.5%, which presented as rent in the uterus which was not bleeding. Both patients were managed conservatively with uneventful puerperium. Conclusion: This study compared different conventional methods of induction in patients with previous one lower segment cesarean section (LSCS). The most important predictor of a successful trial of labor after cesarean deliveries (TOLAC) is a vaginal delivery before or after a cesarean and a favorable preinduction Bishops score >5. On comparing various methods of induction, the addition of mifepristone in cases where fetal prognosis is not desired, accelerated and completed vaginal birth after cesarean section safely. The combination of chemical and mechanical methods of induction resulted in increasing the success rate of TOLAC without increasing any complications. The most common indication of repeat cesarean was non-progress of labor causing cervical dystocia and non-decent of the head. Strict, vigorous, and vigilant intrapartum maternal and fetal monitoring and judicious use of mechanical and chemical methods have definitely, substantially resulted in successful TOLAC deliveries.

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