Obstetric outcomes associated with induction of labour after caesarean section.

PURPOSE: To evaluate the efficiency and safety of inducing labour with oxytocin in women with a single prior Caesarean section, with particular focus on the Bishop score. METHODS: Between January 1, 2013 and March 31, 2017, we included all women with a singleton full-term pregnancy and single prior Caesarean section in this monocentric retrospective observational study. Women for whom vaginal delivery was not recommended and those who went into spontaneous labour were excluded. The choice between induction of labour and caesarean section was made by the obstetrician and the patient, taking into account both the patient's personal medical history and the clinical observations on admission to hospital. The primary outcome was the rate of vaginal delivery. RESULTS: Out of 966 women with no contraindication to trial of labour after previous caesarean delivery (TOLAC), 248 were induced, with a vaginal delivery rate of 58.5% (95% CI [52.06; 64.67]). This rate was 81.7% (67/82) among women with Bishop ≥6 and 47% (78/166) if Bishop was <6. Eight cases of uterine rupture were reported in the induction of labour group. Regarding maternal morbidity, this was the main difference between the caesarean section and the induction of labour groups (p=0.049). Neonatal morbidity was low in both groups. CONCLUSIONS: The rate of vaginal delivery after induction of labour with oxytocin infusion was satisfactory. Nevertheless, maternal morbidity and especially the risk of uterine rupture were not minor. It is thus essential before inducing labour to inform the woman about the rate of success of TOLAC and the risks of uterine rupture.

Non-invasive fetal monitoring using electrocardiography and phonocardiography: A preliminary study.

BACKGROUND: Continuous fetal monitoring is commonly used during pregnancy and labor to assess fetal wellbeing. The most often used technology is cardiotocography (CTG), but this technique has major drawbacks in clinical use. OBJECTIVES: Our aim is to test a non-invasive multimodal technique of fetal monitoring using phonocardiography (PCG) and electrocardiography (ECG) and to evaluate its feasibility in clinical practice, by comparison with CTG. METHODS: This prospective open label study took place in a French university hospital. PCG and ECG signals were recorded using abdominal and thoracic sensors from antepartum women during the second half of pregnancy, simultaneously with CTG recording. Signals were then processed to extract fetal PCG and ECG and estimate fetal heart rate (FHR). RESULTS: A total of 9 sets of recordings were evaluated. Very accurate fetal ECG and fetal PCG signals were recorded, enabling us to obtain FHR for several subjects. The FHR calculated from ECG was highly correlated with the FHR from the CTG reference (from 74% to 84% of correlation). CONCLUSION: This work with preliminary signal processing algorithms proves the feasibility of the approach and constitutes the beginnings of a unique database that is needed to improve and validate the signal processing algorithms.