Spontaneous versus induced labor after a previous cesarean delivery

Abstract

To compare maternal and neonatal outcomes in spontaneous versus induced labor after one previous cesarean delivery. Women with one previous cesarean delivery who had spontaneous labor between January 1992 and January 2000 were compared with those whose labor was induced. Three thousand seven hundred forty-six patients had a trial of labor (2943 spontaneous, 803 induced). Those induced had more frequent early postpartum hemorrhage (7.3% versus 5.0%; odds ratio [OR] 1.66; 95% confidence interval [CI] 1.18, 2.32), cesarean delivery (37.5% versus 24.2%; OR 1.84; 95% CI 1.51, 2.25), and neonatal intensive care unit (NICU) admission (13.3% versus 9.4%; OR 1.69; 95% CI 1.25, 2.29). There was a trend toward higher uterine rupture rates in those with induced versus spontaneous labor (0.7% versus 0.3%, P = .128) and for patients undergoing dinoprostone (prostaglandin E₂) induction versus other methods (1.1% versus 0.6%, P = .62), although neither difference achieved statistical significance. Induced labor is associated with an increased rate of early postpartum hemorrhage, cesarean delivery, and neonatal ICU admission. The higher rate of uterine rupture in those who had labor induced was not statistically significant.