The rate of attempted vaginal birth after cesarean has decreased during the past 15 years. Most of the change since the mid 1990s is the result of increasing reports of uterine rupture during trial of labor, with the highest rates related to labor induction. Not all induction agents have the same magnitude of increased risk of uterine rupture, and there have been only a small number of randomized controlled trials of labor induction in women with previous cesarean delivery. Evaluation of the evidence on specific methods of induction reveals that the lowest rate of uterine rupture occurs with oxytocin at 1.1% (95% confidence interval [CI], 0.9%–1.5%) then dinoprostone at 2% (95% CI, 1.1%–3.5%), and the highest rate is with misoprostol, 6% (95% CI, 0.74%–51.4%). We review the incidence of uterine rupture during induction of labor after previous cesarean and examine the methods of induction and the safety of different techniques for cervical ripening, induction, and/or augmentation of labor in women with previous cesarean delivery.
Target Audience: Obstetricians and Gynecologists, Family Physicians
Learning Objectives: After completing this CME activity, physicians should be better able to assess the complications associated with different methods of induction of labor following previous cesarean delivery, identify the clinical situations associated with increased risk of uterine rupture, and evaluate the methods of induction of different techniques for cervical ripening, induction, and/or augmentation of labor in women with previous cesarean delivery.