Dinoprostone superior to Foley catheter balloon induction for patients with prior C-section

1. For patients with one prior C-section, the induction of labour to delivery time was 10 hours quicker with controlled release dinoprostone induction compared to Foley catheter balloon induction.

2. No differences in maternal satisfaction were found for either method of labour induction.

Evidence Rating Level: 1 (Excellent)

For patients with a previous C-section delivery, labour induction is considered to be risky, due to higher rates of uterine scar rupture, 2.5% when induced with prostaglandins, 0.7% when induced with non-prostaglandins, and 0.5% when labour is spontaneous. However, labour induction is done in 27-32.7% of those who try for a vaginal birth after C-section (VBAC), and is accepted in high-resource settings with informed patient consent. For an unriped cervix, Foley catheter balloon and controlled release dinoprostone vaginal inserts are two methods of inducing labour, and a 2018 systematic review found no differences in safety or effectiveness for patients without a prior C-section. Therefore, this current randomized controlled trial compared the time to delivery and satisfaction outcomes for these two labour induction techniques, among patients with one prior C-section. The study population consisted of 78 women, with 39 randomized to each treatment group. Each participant had a Bishop Score of 5 or less, intact membranes, and no more than 2 contractions in 10 minutes. The results showed that the induction to delivery time was 10 hours longer in the Foley catheter group than the dinoprostone group, with a median [IQR] interval of 33.5 [26.1-36.2] and 23.5 [12.7-34.5] hours respectively (p = 0.004). As well, there were no differences in maternal satisfaction on the 100-point visual analog scale, with a median score of 80 [64-88] and 82 [67-88] for the Foley catheter and dinoprostone respectively. There were also no uterine ruptures in the trial (95% CI 0-5.6%). Overall, this study showed that for patients with one prior C-section, time to delivery following controlled release dinoprostone labour induction was significantly quicker compared to the use of a Foley catheter balloon, although no differences in satisfaction were found.

Click to read the study in Obstetrics and Gynecology

Image: PD

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