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Induction of Labour With Prostaglandin Gel in Grand Multipara with a Previous Caesarean Delivery

Published:December 18, 2018DOI:https://doi.org/10.1016/j.jogc.2018.09.005

      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.

      KEY WORDS

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