This paper reviews the literature to elucidate the international stance on induction of labour in women with previous caesarean section.
There is no evidence to suggest that current induction methods are less effective in women with previous caesarean section. It would, therefore, seem logical to use the same regimens as for women with intact uteri, including prostaglandins, particularly in women with unfavourable cervices. The clinical decision making and counselling, however, will always focus on safety, not effectiveness. There is no question that induction of labour is associated with higher risk of uterine rupture, but quantifying this risk remains elusive.
For the present, we will continue our practice, based on the sources of the best evidence available. Improvements in obstetric care have not only reduced the risks associated with uterine rupture but also risks associated with caesarean section. Therefore, both elective caesarean section and induction of labour, with or without prostaglandins, are reasonable choices for women who need induction with previous caesarean section. The efforts to better quantify the benefits/risks of various policies and regimens should continue, but should be complemented with qualitative studies to obtain crucial insight into the demands and challenges confronting women and clinicians to identify factors influencing their decision-making or their preferences.
aDepartment of Obstetrics and Gynaecology, Arrowe Park Hospital, Wirral, Merseyside, UK
bSchool of Reproductive Medicine, University of Liverpool, Liverpool, UK
Correspondence to Professor Zarko Alfirevic, Professor in Fetal and Maternal Medicine, School of Reproductive Medicine, University of Liverpool, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, L8 7SS, UK e-mail: email@example.com