Paradigm switch: are prostaglandins safe in women with prior CD?

  • J Obstet Gynaecol Can

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • The use of prostaglandins for cervical ripening did not increase risk for uterine rupture in women with 1 prior cesarean delivery (CD).

Why this matters

  • The risk for uterine rupture in a woman with a previous CD has been reported to be 0.5%-1.0%.
  • The use of prostaglandins in a woman with a prior CD has been discouraged in the United States because of concern for increased uterine rupture risk.

Key results

  • No significant differences in rates of vaginal delivery, CD, bleeding requiring transfusion, 5-minute Apgar score ≤7, or neonatal death between groups.
  • 1 case of uterine rupture in each group.
  • 1 case of uterine scar dehiscence diagnosed during repeat CD.

Study design

  • Prospective cohort study.
  • Women with a parity of ≥5 with 1 prior CD undergoing induction of labor (IOL) with 1 mg PGE2 gel (n=96) compared with women without prior CD undergoing IOL with 1 mg PGE2 gel (n=104).
  • Rates of successful IOL, repeat CD, uterine scar rupture or dehiscence, and neonatal outcomes compared.
  • Funding: None disclosed.

Limitations

  • Small number of patients because of restrictive inclusion criteria.

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