Efficacy and safety of induction of labour in case of pregnancy
termination or intrauterine fetal death in patients with a scarred
uterus: a retrospective cohort study
Abstract
Objective: Assess efficacy and safety of labour induction in women with
one or more previous caesarean deliveries during second and third
trimester pregnancy termination or intrauterine fetal death. Design:
Retrospective single-centre study between 2007 and 2018. Setting: Lille,
France Population: 136 women with history of previous caesarean
deliveries (CD) (study group) and 272 controls undergoing labour
induction for pregnancy termination or intrauterine fetal death.
Methods: Before 32 weeks, misoprostol 400 μg was given orally every 3
hours up to a maximum of five doses in 24 hours. Study group received
half doses. After 32 weeks, oxytocin infusion, misoprostol (PGE1) or
PGE2 (dinoprostone) were used according to the Bishop score. Main
outcome measures: Vaginal delivery within the 24 hours after induction
without uterine rupture or severe post-partum haemorrhage defined as
blood loss > 1 litre (PPH). Results: Vaginal delivery
within the 24 hours after induction without uterine rupture or PPH was
83.5% in the study group versus 92.6% in the control group (p=0.005).
5 (3.7%) uterine ruptures occurred in the study group, 1.7% in case of
one previous CD and 15.8% in case of 2 or more previous CD. There were
more severe PPH in the study group (6.7% versus 2.2% p=0.03), but no
difference was found between women with one or more previous CD.
Conclusions: Women with 2 or more prior CD should be informed that they
are at higher risk of complications such as uterine rupture and severe
post-partum haemorrhage.