[Induction of labor and intrapartum management for women with uterine scar]

Abstract

Objectives: To evaluate the benefits and risks of labor induction in patients previously delivered by at least one low transverse cesarean section. To define how labor should be managed in patients attempting a vaginal birth after cesarean section (VBAC).

Methods: A literature search was performed using the Pubmed(®) and Cochrane(®) databases. Foreign societies guidelines were also consulted.

Results: Labor induction is associated with an increased risk of uterine rupture that could be estimated at 1% with oxytocine and 2% with vaginal prostaglandins (Level 2). Mechanical methods have been insufficiently studied. Misoprostol seems to dramatically increase the risk of uterine rupture (Level 3). The routine use of intrauterine pressure catheter does not prevent uterine rupture (Professional agreement). A moderate increase of uterine rupture was also found with augmentation (Level 3). The risk of uterine rupture increases when cervical dilatation is arrested for 3 hours or more when a good uterine dynamic is obtained (Professional agreement). The use of epidural analgesia should be encouraged (Grade C). Routine digital exploration of the uterine scare postpartum is not necessary (Grade C).

Conclusion: Women attempting a VBAC should be aware of the modalities of labor management. When labor induction is warranted, women should also be informed of the indication and the increased risk of uterine rupture. The choice of labor induction method should take into consideration maternal and obstetrical characteristics.

Copyright © 2012. Published by Elsevier Masson SAS.