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Mechanical Methods for the Induction of Labour After Previous Caesarean Section – An Updated, Evidence-based Review

There are currently no up-to-date evidence-based recommendations on the preferred method to induce labour after previous Caesarean section, especially for patients with unripe cervix, as randomised controlled studies are lacking. Intravenous oxytocin and misoprostol are contraindicated in these wome...

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Autores principales: Rath, Werner, Hellmeyer, Lars, Tsikouras, Panagiotis, Stelzl, Patrick
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2022
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9262630/
https://www.ncbi.nlm.nih.gov/pubmed/35815098
http://dx.doi.org/10.1055/a-1731-7441
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author Rath, Werner
Hellmeyer, Lars
Tsikouras, Panagiotis
Stelzl, Patrick
author_facet Rath, Werner
Hellmeyer, Lars
Tsikouras, Panagiotis
Stelzl, Patrick
author_sort Rath, Werner
collection PubMed
description There are currently no up-to-date evidence-based recommendations on the preferred method to induce labour after previous Caesarean section, especially for patients with unripe cervix, as randomised controlled studies are lacking. Intravenous oxytocin and misoprostol are contraindicated in these women because of the high risk of uterine rupture. In women with ripe cervix (Bishop Score > 6), intravenous administration of oxytocin is an effective procedure with comparable rates of uterine rupture to those with spontaneous onset of labour. Vaginal prostaglandin E (2) (PGE (2) ) and mechanical methods (balloon catheters, hygroscopic cervical dilators) are effective methods to induce labour in pregnant women with unripe cervix and previous Caesarean section. According to current guidelines, the administration of PGE (2) is associated with a higher rate of uterine rupture compared to balloon catheters. Balloon catheters are therefore a suitable alternative to PGE (2) to induce labour after previous Caesarean section, even though this is an off-label use. In addition to two meta-analyses published in 2016, 12 mostly retrospective cohort/observational studies with low to moderate levels of evidence have been published on mechanical methods of cervical ripening after previous Caesarean section. But because of the significant heterogeneity of the studies, substantial differences in study design, and insufficient numbers of pregnant women included in the studies, it is not possible to make any evidence-based recommendations based on these studies. According to a recent meta-analysis, the average rate using balloon catheters is approximately 53% and the average rate after spontaneous onset of labour is 72%. The uterine rupture rate was 0.2–0.9% for vaginal PGE (2) and 0.56–0.94% for balloon catheters and is therefore comparable to the uterine rupture rate associated with spontaneous onset of labour. According to the product informations, hygroscopic cervical dilators (Dilapan-S) are currently the only method which is not contraindicated for cervical ripening/induction of labour in women with previous Caesarean section, although data are insufficient. Well-designed, randomised, controlled studies with sufficient case numbers comparing balloon catheters and hygroscopic cervical dilators with mechanical methods and vaginal prostaglandin E (2) /oral misoprostol are therefore necessary to allow proper decision-making.
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spelling pubmed-92626302022-07-08 Mechanical Methods for the Induction of Labour After Previous Caesarean Section – An Updated, Evidence-based Review Rath, Werner Hellmeyer, Lars Tsikouras, Panagiotis Stelzl, Patrick Geburtshilfe Frauenheilkd There are currently no up-to-date evidence-based recommendations on the preferred method to induce labour after previous Caesarean section, especially for patients with unripe cervix, as randomised controlled studies are lacking. Intravenous oxytocin and misoprostol are contraindicated in these women because of the high risk of uterine rupture. In women with ripe cervix (Bishop Score > 6), intravenous administration of oxytocin is an effective procedure with comparable rates of uterine rupture to those with spontaneous onset of labour. Vaginal prostaglandin E (2) (PGE (2) ) and mechanical methods (balloon catheters, hygroscopic cervical dilators) are effective methods to induce labour in pregnant women with unripe cervix and previous Caesarean section. According to current guidelines, the administration of PGE (2) is associated with a higher rate of uterine rupture compared to balloon catheters. Balloon catheters are therefore a suitable alternative to PGE (2) to induce labour after previous Caesarean section, even though this is an off-label use. In addition to two meta-analyses published in 2016, 12 mostly retrospective cohort/observational studies with low to moderate levels of evidence have been published on mechanical methods of cervical ripening after previous Caesarean section. But because of the significant heterogeneity of the studies, substantial differences in study design, and insufficient numbers of pregnant women included in the studies, it is not possible to make any evidence-based recommendations based on these studies. According to a recent meta-analysis, the average rate using balloon catheters is approximately 53% and the average rate after spontaneous onset of labour is 72%. The uterine rupture rate was 0.2–0.9% for vaginal PGE (2) and 0.56–0.94% for balloon catheters and is therefore comparable to the uterine rupture rate associated with spontaneous onset of labour. According to the product informations, hygroscopic cervical dilators (Dilapan-S) are currently the only method which is not contraindicated for cervical ripening/induction of labour in women with previous Caesarean section, although data are insufficient. Well-designed, randomised, controlled studies with sufficient case numbers comparing balloon catheters and hygroscopic cervical dilators with mechanical methods and vaginal prostaglandin E (2) /oral misoprostol are therefore necessary to allow proper decision-making. Georg Thieme Verlag KG 2022-03-16 /pmc/articles/PMC9262630/ /pubmed/35815098 http://dx.doi.org/10.1055/a-1731-7441 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Rath, Werner
Hellmeyer, Lars
Tsikouras, Panagiotis
Stelzl, Patrick
Mechanical Methods for the Induction of Labour After Previous Caesarean Section – An Updated, Evidence-based Review
title Mechanical Methods for the Induction of Labour After Previous Caesarean Section – An Updated, Evidence-based Review
title_full Mechanical Methods for the Induction of Labour After Previous Caesarean Section – An Updated, Evidence-based Review
title_fullStr Mechanical Methods for the Induction of Labour After Previous Caesarean Section – An Updated, Evidence-based Review
title_full_unstemmed Mechanical Methods for the Induction of Labour After Previous Caesarean Section – An Updated, Evidence-based Review
title_short Mechanical Methods for the Induction of Labour After Previous Caesarean Section – An Updated, Evidence-based Review
title_sort mechanical methods for the induction of labour after previous caesarean section – an updated, evidence-based review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9262630/
https://www.ncbi.nlm.nih.gov/pubmed/35815098
http://dx.doi.org/10.1055/a-1731-7441
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