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More high-quality studies are needed to gauge the safety of induced labor in women who have had prior cesarean deliveries

Vaginal birth for women who have previously undergone cesarean section has been actively promoted as a way to reduce the rising cesarean delivery (CD) rates in the United Kingdom and the United States. A systematic review of studies on the topic concludes there is little high-quality evidence to guide clinical or health policy decisions regarding the safety of inducing labor in women who have had a prior CD. The study, supported by the Agency for Healthcare Research and Quality (HS11338), was conducted by the Oregon Health & Science University Evidence-based Practice Center.

Researchers reviewed 162 articles, identified 14 fair-quality studies, and found no good-quality studies reporting outcomes data for women with induced labors and prior CD. Compared with spontaneous labor, induction was more likely to result in CD. Of women undergoing spontaneous labor, 20 percent had CD compared with 32 percent receiving oxytocin to induce labor. In studies of prostaglandin E2 (PGE2), 24 percent of women undergoing spontaneous labor had CD compared to 48 percent whose labor was induced with PGE2.

There was a nonsignificant increase in uterine ruptures among women whose labors were induced compared with those who had spontaneous labors. There were no maternal deaths and other maternal complications, such as bleeding or infection, were infrequently reported. Four studies reported on infant deaths, and other infant outcomes were inadequately reported. The researchers indicate that better quality studies are needed that consider potential confounding factors, such as dose of induction medicine and reasons for induction, as well as appropriate comparison groups.

See "The benefits and risks of inducing labor in patients with prior cesarean delivery: A systematic review," by Marian S. McDonagh, Pharm.D., Patricia Osterweil, and Jeanne-Marie Guise, M.D., M.P.H., in the August 2005 International Journal of Obstetrics and Gynaecology 112, pp. 1007-1015.

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