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Prior Cesarean: A Contraindication to Labor Induction?

MAULDIN, JILL G. MD; NEWMAN, ROGER B. MD

Clinical Obstetrics & Gynecology: September 2006 - Volume 49 - Issue 3 - pp 684-697
Symposium on Cervical Ripening and Labor Induction

In 2004, cesarean rates were the highest ever in the United States. Simultaneously, the vaginal birth after cesarean (VBAC) rate fell, largely a result of reports of uterine rupture associated with VBAC attempts. This chapter reviews the efficacy and safety of VBAC associated with labor induction. Mechanical and pharmacologic methods of labor induction (notably misoprostol) are associated with increased maternal and perinatal morbidity compared with spontaneous VBAC attempts. However, the absolute risks remain low. Labor induction is not contraindicated in women with a prior cesarean but sound judgment, clinical precautions and specific consent are required.

Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina

Correspondence: Jill Mauldin, MD, Department of Obstetrics and Gynecology, Medical University of SC, 96 Jonathan Lucas Street, Suite 634, PO Box 250619, Charleston, SC 29425. E-mail: mauldinj@musc.edu

© 2006 Lippincott Williams & Wilkins, Inc.