Induction of Labor in Women with Previous Cesarean Section and Unfavorable Cervix: A Retrospective Cohort Study

Chiara Germano; Ilenia Mappa; Antonella Cromi; Enrico Busato; Maddalena Incerti; Andrea Lojacono; Giuseppe Rizzo; Rossella Attini; Lodovico Patrizi; Alberto Revelli; Bianca Masturzo

doi:10.3390/healthcare11040543

Induction of Labor in Women with Previous Cesarean Section and Unfavorable Cervix: A Retrospective Cohort Study

Healthcare (Basel). 2023 Feb 12;11(4):543. doi: 10.3390/healthcare11040543.

Authors

Affiliations

¹ Department of Obstetrics and Gynaecology 2U, Sant'Anna Hospital, University of Turin, 10126 Turin, Italy.
² Obstetrics and Gynaecology Department, Infermi Hospital, University of Turin, 10124 Turin, Italy.
³ Division of Maternal Fetal Medicine Ospedale Cristo Re, University of Roma Tor Vergata, 00133 Rome, Italy.
⁴ Obstetrics and Gynaecology Department, Filippo del Ponte Hospital, University of Insubria, 21100 Varese, Italy.
⁵ Obstetrics and Gynaecology Department, Ca' Foncello Hospital, 31100 Treviso, Italy.
⁶ Obstetrics and Gynaecology Department, San Gerardo Hospital, 20900 Monza, Italy.
⁷ Obstetrics and Gynaecology Department, Spedali Civili Hospital, University of Brescia, 25123 Brescia, Italy.
⁸ Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, University of Roma Tor Vergata, 00133 Rome, Italy.

Abstract

Background: The efficacy and safety of a cervical ripening balloon (CRB) in women with a previous cesarean section (CS) and unfavorable Bishop score are still controversial. Methods: A retrospective cohort study was performed across six tertiary hospitals from 2015 to 2019. Women with one previous transverse CS, singleton cephalic term pregnancy and BS < 6 were included if submitted to labor induction with a CRB. The main outcome was the rate of vaginal birth after cesarean (VBAC) after CRB ripening. Secondary outcomes were abnormal composite fetal and maternal outcomes. Results: Of the 265 women included, 57.3% had successful vaginal birth. Augmentation improved vaginal delivery (32.2% vs. 21.2%). Intrapartum analgesia was associated with an increased VBAC rate (58.6% vs. 34.5%). Maternal BMI ≥30 and age ≥40 years increased emergency CS rate (11.8% vs. 28.3% and 7.2 vs. 15.9%). Composite adverse maternal outcome occurred in 4.8% of CRB group women and increased to 17.6% when associated with oxytocin. Uterine rupture occurred in one case (0.4%) in the CRB-oxytocin group. Poorer fetal outcome occurred after emergency CS, if compared to successful VBAC (12.4% vs. 3.3%). Conclusions: In women with a previous CS and unfavorable Bishop score, induction of labor with a CRB can be considered safe and effective.

Keywords: cervical ripening balloon; cesarean section; trial of labor after cesarean section; unfavorable cervix.

Grants and funding

The authors did not receive support from any organization for the submitted work. No funding was received to assist with the preparation of this manuscript. No funding was received for conducting this study. No funds, grants, or other support was received.