Risk of uterine rupture with the use of prostaglandin E2 for induction of labor in women with a previous cesarean section scar

ABSTRACT

To determine the risk of symptomtic uterine rupture in women induced with prostaglandin E[2] vaginal tablet [PGE[2]] after 1 previous cesarean section. A cohort study of all women with a live singleton fetus undergoing a trial of labor [TOL] after a previous low - transverse cesarean delivery was performed in King Faisal Armed Forces Hospital, Saudi Arabia. The current analysis was limited to women at term with 1 prior cesarean delivery. We assessed the risk of uterine rupture for deliveries with spontaneous onset of labor and those in which labor was induced by PGE[2] vaginal tablets. Rates of uterine rupture were compared for these 2 groups. Potential confounding variables were controlled by using logistic regression analysis. Of 3200 trials of labor, 960 [30%] were PGE[2] induced and 2240 [70%] were spontaneous labor. The uterine rupture rate with PGE[2] - induced trial of labor [24 / 960; 2.5%] was significantly higher than with a spontaneous trials of labor [11 / 2240; 0.50%; P = 0.01]. In a logistic regression analysis that was controlled for maternal age, use of epidural analgesia, oxytocin augmentation, birth weight, gestational age, year of trial of labor, and prior vaginal delivery, the odds ratio for uterine rupture in those patients with PGE[2] - induced trial of labor was 5.1 [95% confidence interval, 1.9 -14.2]. For women with one prior cesarean delivery, induction of labor with PGE[2] is associated with an almost 5 - fold greater risk of uterine rupture than those who deliver after spontaneous labor