Oxytocin induction after previous cesarean delivery

OBJECTIVE: Oxytocin use during a trial of labor is not associated with increased perinatal mortality rates. Less is known about induction of labor after a previous lower segment incision (ACOG). Therefore, we sought to determine whether induction of labor using standard oxytocin protocols during a trial of labor (TOL) after prior cesarean was safe and effective. METHODS: All gravid women with at least one prior cesarean birth at University Hospital from July 1, 1970, to June 30, 1995 were reviewed. Induction of labor was performed for obstetrical indications (e.g. preeclampsia, post-term and maternal medical complications). Comparisons were made between oxytocin induction and spontaneous labor groups. RESULTS: 8742 women with one or more prior cesarean sections delivered during the study period. 47% (n = 4150) underwent a trial of labor, of whom 576 (13.9%) underwent induction. 74% (426/576) in the induction group delivered vaginally, compared to 86% (3074/3574) in the spontaneous labor group (p < 0.01). Neonatal Complications (%) Maternal Complications (%) Sponl. Indue. Spont. Induc. Apgar <7 1.7 3.4 PP Hemm 2.6 0.7 PNM 1.8 1.0 Rupture 0.2 0.3 Sepsis 0.6 0.8 Hyst. 1.4 4.3 Seizures 0.1 0 ( p < 0.01 vs Spont.) The increased incidence of hysterectomy in the induction group was due to uterine atony. CONCLUSION: The use of induction should be considered favorably in patients with prior cesarean sections who require delivery for obstetrical indications, however, caution should be taken during oxytocin administration.