Research
Obstetrics
Obstetric outcomes associated with induction of labor after 2 prior cesarean deliveries

Presented at the 35th annual meeting of the Society for Maternal-Fetal Medicine, San Diego, CA, Feb. 2-7, 2015.
https://doi.org/10.1016/j.ajog.2015.02.003Get rights and content

Objective

We sought to determine whether, in the setting of induction, obstetric outcomes differ based on the number of prior cesarean deliveries (CD) and to determine whether women with 2 cesareans undergoing induction face increased risks of adverse outcomes compared to women undergoing a repeat CD.

Study Design

This is a secondary analysis of a 4-year multicenter prospective cohort. Women with 1 or 2 CD were included. Frequencies of vaginal birth after cesarean as well as maternal and neonatal complications were compared among women with 1 CD undergoing induction, women with 2 CD undergoing induction, and women undergoing repeat CD with 2 cesareans.

Results

Of the 10,262 women included in this study, 4100 (40.0%) underwent an induction after 1 CD, 152 (1.5%) underwent an induction after 2 CD, and 6010 (58.6%) had a repeat CD after 2 CD. In women undergoing induction, the chance of vaginal birth after cesarean was no different in women with 2 compared to 1 prior CD (65% vs 69%, P = .28). Similarly, composite maternal (adjusted odds ratio [aOR], 1.2; 95% confidence interval [CI], 0.6–2.3) and neonatal (aOR, 1.1; 95% CI, 0.7–1.7) outcomes were not different between the 2 groups. In women who had 2 prior CD, undergoing an induction carried similar composite adverse maternal and neonatal outcomes compared to having a repeat CD (aOR, 0.7; 95% CI, 0.3–2.0; aOR, 1.1; 95% CI, 0.6–2.2).

Conclusion

Labor induction outcomes are similar regardless of whether women have had 1 or 2 CD. After 2 CD, undergoing an induction carries similar maternal and neonatal risks as having a repeat CD.

Section snippets

Materials and Methods

This is a secondary analysis of an observational study of women at 19 academic medical centers from 1999 through 2002. The methodology of the primary study has been described elsewhere.2 Women were included in the present analysis if they had 1 or 2 prior CD, a singleton gestation, and no contraindication to a vaginal delivery (eg, placenta previa, breech presentation). Women with anomalous fetuses or antenatal stillbirths were excluded. Women with prior classic, T or J, or low vertical

Results

There were 10,262 women included in this analysis. Of these, 4252 underwent an induction of labor. In all, 152 (3.6%) of those undergoing induction had 2 prior CD and 6010 (58.6%) had a repeat CD after 2 prior CD.

Comparisons between women undergoing induction with 1 or 2 prior cesareans as well as comparisons between women with 2 prior cesareans undergoing induction vs repeat cesarean without a trial of labor are shown in Table 1. Most notably, women with 2 prior cesareans undergoing induction

Comment

Compared to women without a prior cesarean, women with 2 prior CD are at an increased risk of pregnancy complications regardless of the intended mode of delivery. Further compounding this issue is the fact that spontaneous labor does not always occur and induction of labor carries potential additional risks. For example, in women with 1 prior CD, induction of labor (compared to spontaneous labor) is associated with a decreased chance of VBAC.5, 6, 7, 8 While ACOG still considers induction of

References (13)

There are more references available in the full text version of this article.

Cited by (17)

  • Induction of labour in patients with prior caesarean births or uterine surgery

    2022, Best Practice and Research: Clinical Obstetrics and Gynaecology
  • N<sup>o</sup> 382 – Épreuve de travail après césarienne

    2019, Journal of Obstetrics and Gynaecology Canada
    Citation Excerpt :

    ont examiné la différence en cas de DAT chez les femmes ayant 1 (4 100 femmes) ou 2 césariennes préexistantes (152 femmes) 79. Dans les deux groupes, les taux d'AVAC étaient plus faibles (69 % et 65 %) que les estimations globales des taux d'AVAC en général79. Ils ont constaté que les issues maternelles et néonatales combinées en cas de DAT chez les femmes ayant 2 césariennes préexistantes qui se soumettent à une EDTAC étaient semblables à celles des femmes ayant 1 césarienne préexistante et celles qui subissaient une CIP79.

  • No. 382-Trial of Labour After Caesarean

    2019, Journal of Obstetrics and Gynaecology Canada
    Citation Excerpt :

    They reported that maternal and neonatal composite outcomes in women with 2 prior CS undergoing IOL and TOLAC are similar to those women with 1 prior CS and to those having an ERCS.79 It is important to note that although the total sample size is large (10 262 women) in this study, the case group was limited to only 152 women with 2 prior CSs undergoing a TOLAC.79 Women with 2 prior Caesarean sections appear to have similar vaginal birth after Caesarean rates as those with 1 prior Caesarean section.

  • Obstetric outcomes associated with induction of labour after caesarean section

    2018, Journal of Gynecology Obstetrics and Human Reproduction
  • Cervical ripening agents in the second trimester of pregnancy in women with a scarred uterus: a systematic review and metaanalysis of observational studies

    2016, American Journal of Obstetrics and Gynecology
    Citation Excerpt :

    Different methods of cervical ripening have been used, including synthetic prostaglandins (PGE1 and PGE2, PGF2α), and mechanical methods such as dilatation using laminaria, Foley catheter, Cook balloon, or double balloon devices.78-80 However, most studies of labor induction have been focused on the third trimester of pregnancy in women without uterine scar.81-90 Thus, the efficacy and safety profile of these methods of induction of labor in the second trimester in women with previous CD has remained largely unknown.

View all citing articles on Scopus

The authors report no conflict of interest.

Cite this article as: Miller ES, Grobman WA. Obstetric outcomes associated with induction of labor after 2 prior cesarean deliveries. Am J Obstet Gynecol 2015;213:89.e1-5.

View full text