The benefits and risks of inducing labour in patients with prior caesarean delivery: A systematic review

Marian McDonagh, Patricia Osterweil, Jeanne-Marie Guise

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Objective: To evaluate the risks and benefits of inducing labour in women with a prior caesarean delivery. Design: Systematic review. Sample: Pregnant women with prior caesarean delivery. Methods: Studies were identified using MEDLINE, EMBASE, HealthSTAR, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effectiveness, reference lists and experts. Main outcome measures: All studies reporting data for outcomes in women with induced labours and prior caesarean were eligible. Methodologic quality was evaluated using the criteria of the U.S. Preventive Services Task Force and the NHS Centre for Reviews and Dissemination. We assigned studies good, fair or poor rating. Results: We reviewed 162 full text articles, identified 14 fair-quality studies, and found no good-quality studies. Compared with spontaneous labour, induction was more likely to result in caesarean delivery. Of women undergoing spontaneous labour, 20% had a caesarean (range 11-35%) compared with 32% receiving oxytocin (range 18-44%). In studies of PGE2, spontaneous labour resulted in caesarean delivery in 24% (range 18-51%) compared with 48% with PGE2 (range 28-51%). There was a non-significant increase in uterine ruptures among those induced compared with spontaneous labours. There were no maternal deaths; other maternal complications were infrequently reported. Only four studies reported on infant deaths; other infant outcomes were inadequately reported. Conclusion: Women with a history of caesarean attempting trial of labour who require induction have a higher rate of caesarean delivery and have a slightly elevated risk of rupture compared with similar women with spontaneous labour. More consideration is needed for potential confounders: dose, reasons for induction and appropriate comparison groups.

Original languageEnglish (US)
Pages (from-to)1007-1015
Number of pages9
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume112
Issue number8
DOIs
StatePublished - Aug 2005

Fingerprint

Induced Labor
Dinoprostone
Trial of Labor
Databases
Uterine Rupture
Maternal Death
Advisory Committees
Oxytocin
MEDLINE
Pregnant Women
Rupture
Research Design
Mothers
Outcome Assessment (Health Care)
Infant Death

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

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title = "The benefits and risks of inducing labour in patients with prior caesarean delivery: A systematic review",
abstract = "Objective: To evaluate the risks and benefits of inducing labour in women with a prior caesarean delivery. Design: Systematic review. Sample: Pregnant women with prior caesarean delivery. Methods: Studies were identified using MEDLINE, EMBASE, HealthSTAR, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effectiveness, reference lists and experts. Main outcome measures: All studies reporting data for outcomes in women with induced labours and prior caesarean were eligible. Methodologic quality was evaluated using the criteria of the U.S. Preventive Services Task Force and the NHS Centre for Reviews and Dissemination. We assigned studies good, fair or poor rating. Results: We reviewed 162 full text articles, identified 14 fair-quality studies, and found no good-quality studies. Compared with spontaneous labour, induction was more likely to result in caesarean delivery. Of women undergoing spontaneous labour, 20{\%} had a caesarean (range 11-35{\%}) compared with 32{\%} receiving oxytocin (range 18-44{\%}). In studies of PGE2, spontaneous labour resulted in caesarean delivery in 24{\%} (range 18-51{\%}) compared with 48{\%} with PGE2 (range 28-51{\%}). There was a non-significant increase in uterine ruptures among those induced compared with spontaneous labours. There were no maternal deaths; other maternal complications were infrequently reported. Only four studies reported on infant deaths; other infant outcomes were inadequately reported. Conclusion: Women with a history of caesarean attempting trial of labour who require induction have a higher rate of caesarean delivery and have a slightly elevated risk of rupture compared with similar women with spontaneous labour. More consideration is needed for potential confounders: dose, reasons for induction and appropriate comparison groups.",
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