Abstract
Objective
This study sought to evaluate the safety of induction of labour with prostaglandin
E2 (PGE2) gel in grand multiparous (GMP) women and to compare the labour outcome of GMP women
who have undergone one previous Caesarean section (CS) with that of GMP women who
never had a previous CS.
Methods
This prospective cohort study (Canadian Task Force Classification II-2) evaluated
induction of labour with 1 mg of PGE2 gel in 96 GMP women with one previous CS (study group) and in 104 GMP women without
previous CS (control group).
Results
One uterine rupture occurred in the study group (1%), and another occurred in the
control group (0.9%). Additional oxytocin was used in seven patients (7.3%) in the
study group and in 28 others (26.9%) in the control group (P = 0.002). Both uterine ruptures occurred with oxytocin augmentation. One case of
uterine scar dehiscence was found in the study group. There was no significant difference
between the study group and the control group regarding the rate of vaginal delivery
(74 [77.1%] vs. 78 [75%]) or the rate of CS (21 [21.9%] vs. 24 [23.1%]), respectively.
There was no significant difference between the groups in 5-minute Apgar scores ≤7.
There was no neonatal death in either group.
Conclusion
A low dose (1.0 mg) of PGE2 gel for induction of labour in GMP women with one previous CS is appropriate and
appears to be safe for both mother and baby. Augmentation by oxytocin should be used
judiciously.
Résumé
Objectif
Cette étude visait à évaluer l'innocuité du déclenchement du travail par l'application
d'un gel de prostaglandine E2 (PGE2) chez les femmes grandes multipares (GMP) et à comparer l'issue du travail des femmes
GMP qui avaient subi une césarienne à celle des femmes GMP qui n'en avaient jamais
subi.
Méthodologie
Cette étude de cohorte prospective (classification II-2 du Groupe d’étude canadien)
a évalué le déclenchement du travail avec 1 mg de gel de PGE2 chez 96 femmes GMP ayant subi une césarienne (groupe à l’étude) et chez 104 femmes
GMP n'ayant jamais subi de césarienne (groupe témoin).
Résultats
Une rupture utérine est survenue dans le groupe à l’étude (1 %), et une autre dans
le groupe témoin (0,9 %). On a utilisé de l'ocytocine supplémentaire chez 7 patientes
(7,3 %) du groupe à l’étude et chez 28 patientes (26,9 %) du groupe témoin (P = 0,002). Les deux ruptures utérines sont survenues après une stimulation à l'ocytocine.
Un cas de déhiscence de cicatrice utérine est survenu dans le groupe témoin. Aucune
différence significative n'a été observée entre le groupe à l’étude et le groupe témoin
en ce qui concerne le taux d'accouchement par voie vaginale (74 [77,1 %] contre 78
[75 %]) et le taux de césarienne (21 [21,9 %] contre 24 [23,1 %]). Aucune différence
significative n'a été observée entre les groupes pour l'obtention d'un indice d'Apgar
inférieur ou égal à 7 après cinq minutes, et aucun décès néonatal n'est survenu dans
les deux groupes.
Conclusion
L'administration d'une faible dose (1,0 mg) de gel de PGE2 pour le déclenchement du travail chez les femmes GMP ayant subi une césarienne est
appropriée et semble sécuritaire pour la mère et le bébé. La stimulation à l'ocytocine
devrait être utilisée avec circonspection.
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Article info
Publication history
Published online: December 18, 2018
Received in revised form:
September 1,
2018
Received:
July 1,
2018
Footnotes
Competing interests: The authors declare that they have no competing interests.
Each author has indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
