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International Journal of Gynecology & Obstetrics 65 Ž Induction of labor with vaginal prostaglandin-E in grand multiparous women with one previous cesarean Department of Obstetrics and Gynecology, King Abdulaziz Uni¨ersity Hospital, Jeddah, Saudi Arabia Received 30 September 1998; received in revised form 21 December 1998; accepted 5 January 1999 Abstract
Objecti¨e: To review the outcome of induction of labor with vaginal prostaglandin-E in grand multiparous women with one previous cesarean section. Methods: Twenty-six grand multiparous women with one previous cesareansection were induced with vaginal prostaglandin-E . Results: Twenty Ž 23.1% women delivered by emergency cesarean section. The mean duration of labor was 6 "3.6 h. There was no uterine rupture or dehiscence. There was one neonatal death and two stillbirths. Conclusions: Our limited studysuggests that induction of labor with vaginal prostaglandin-E in selected grand multiparous women with one previous cesarean section may be a reasonable option. However, further studies are needed to document its safety.
ᮊ 1999 International Federation of Gynecology and Obstetrics.
Keywords: Induction; Prostaglandin-E ; Grand multipara; Previous cesarean 1. Introduction
for uterine rupture Žgrand multiparity, uterinescar, and the use of prostaglandin preparations.
Induction of labor in grand multiparous women However, there is no real data in the literature to support such a recommendation. Induction of section is considered a contraindication. This is labor with vaginal prostaglandin-E in grand mul- because of the combination of three risk factors tiparous women without previous uterine scarproved to be relatively safe w there is insufficient evidence against the use of U Corresponding author. Tel.: q966 26772027; fax: q966 0020-7292r99r$20.00 ᮊ 1999 International Federation of Gynecology and Obstetrics.
PII: S 0 0 2 0 - 7 2 9 2 Ž 9 8 . 0 0 0 1 5 - 6 T.Y. Yamani, A.A. Rouzi r International Journal of Gynecology & Obstetrics 65 ( this study is to review the outcome of induction of A P-value -0.05 was considered statistically sig- labor with vaginal prostaglandin-E in grand mul- tiparous women with one previous cesarean sec-tion.
3. Results
2. Materials and method
The maternal characteristics are shown in Table 1. The majority of our grand multiparous women Between 1 January 1991 and 31 July 1997, 26 grand multiparous women with one previous ce- responded to a maximum of three doses of 1.5 mg Hospital, Jeddah, Saudi Arabia. Analysis of the hospital records showed that they all: Ž .
76.9% multiparous women delivered vaginally medical or obstetrical indication for induction of cesarean section Žthree for fetal distress and three the index pregnancy delivered vaginally. In con- with unripe cervix ŽBishop score - .
who did not have VBAC before delivered vagi- The indications for induction of labor were: Ž .
nally. This was a statistically significant difference 0.01 . The mean duration of labor was 6 "3.6 h. There was no uterine rupture or dehiscence, tum hemorrhage due to uterine atony and were women had had one or more successful VBAC before the index pregnancy and seven women had Apgar score -7 at 5 min. The mean fetal 27% did not have VBAC before Žthe last deliv- weight was 3611.5"486.8 g. Twenty-four babies were delivered alive, but one died in the neonatal The induction of labor and the intrapartum period due to multiple congenital anomalies which were diagnosed antenatally. There were two still- vaginal prostaglandin-E ; half a tablet Ž1.5 mg of births Žcame with history of absent fetal move- serted in the posterior vaginal fornix during vagi-nal examination. This was repeated every 6 h up to three doses provided that the cervix was still unripe and the fetal heart monitoring was reas- suring. Intrapartum continuous fetal heart moni-toring was carried out for all women. Pain relief in labor was provided by intramuscular adminis- tration of pethidine and phenergan. Statistical analysis was performed using SPSS-PC for win- dows, version 6.1. Results are expressed as mean "S.D. Statistical analysis was done with ␹2 test.
Note. Data are presented as mean "S.D.
T.Y. Yamani, A.A. Rouzi r International Journal of Gynecology & Obstetrics 65 ( ments for a few days and were diagnosed as smoothly. The success rate of VBAC in our study intrauterine fetal death before induction.
was 76.9% and we did not have any maternalmortality, or serious morbidity such as uterine 4. Discussion
rupture or dehiscence. However, these resultsshould be considered with caution because of the Induction of labor with vaginal prostaglandin- small number of patients. Furthermore, 19 Ž in multiparous women with one previous ce- of the 26 women had had one or more successful sarean section is controversial. A recent review of the existing literature showed that there is no In conclusion, our limited study suggests that good analytic studies concerning the safety of induction of labor with vaginal prostaglandin-E2 vaginal prostaglandins with one previous cesarean in selected grand multiparous women with one 3 . Eleven retrospective studies included previous cesarean section may be a reasonable 713 women with one previous cesarean section option. However, further studies are needed to who were induced with vaginal and cervical prostaglandin-E . Only two women had dehis- cence of the uterine scar and the success rate of References
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Yamani TY, Rouzi AA. Induction of labor with vaginal rent studies do not support such a statement 9 . In addition, one study based on the out- Crowley P. Contraindications to prostaglandin E vagi- come of delivery of 1700 grand multiparous nal gel: evidence based? SOGC J 1996;18:1143᎐1152.
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