A prospective random allocation trial to compare vaginal prostaglandin E₂with intravenous oxytocin for labour induction in women previously delivered by caesarean section

Abstract

SummaryForty-two women requiring labour induction whose only previous delivery was by lower segment caesarean section were allocated at random to receive either vaginal prostaglandin E2, 2.5 mg followed by amniotomy, or amniotomy and intravenous oxytocin titration. There were no differences in the induction to delivery intervals or mode of delivery for the two groups; however, of six women who required a repeat caesarean section in the oxytocin group, five were for failure to establish labour compared to none out of the four in the prostaglandin group (P < 0.05): the indication for the previous caesarean section may have influenced the outcome. One case of uterine rupture occurred in the prostaglandin group after oxytocin augmentation: the risk of scar rupture remains, particularly if oxytocin augmentation is required. The results of the study suggest that prostaglandins given vaginally may provide a more effective method of induction of labour for women previously delivered by caesarean section, and a large multicentre trial would be justified for this conclusion to be established.