Prostaglandin E₂ Gel Induction of Patients with a Prior Low Transverse Cesarean Section

ABSTRACT

To determine safety and efficacy of induction with prostaglandin E₂ gel, we compared the outcome of 25 patients (study group) with an unfavorable cervix, a medical indication for delivery, and one prior low cervical transverse cesarean section to 56 patients (comparison group) with one prior low cervical transverse cesarean section and spontaneous labor. We placed 1 mg of prostaglandin E₂ in gel intracervically in the 25 study patients. Common indications for delivery were: diabetes, post dates, and pre-eclampsia. Although most labor and delivery variables were similar, the study group had a longer mean latent phase (14.2 ± 13.8 versus 7.3 ± 3.7 hours: p <0.002), but had a shorter mean length of active phase (4.0 ± 3.5 versus 5.7 ± 3.0 hours; p <0.02). None of the patients in either group had a dehiscence of the uterine scar, nor rupture of the uterus. Both groups had a similar cesarean section rate. Since from the few reported, nonrandomized studies it appears that prostaglandin E₂ gel use in patients with a prior low cervical transverse cesarean section may be useful and relatively safe, it may be time to attempt randomized trials of prostaglandin E₂ gel versus oxytocin for induction of patients with a prior low cervical transverse cesarean section, unfavorable cervix, and a medical indication for delivery