Induction of Labour With Prostaglandin Gel in Grand Multigravida With a Previous Caesarean Delivery.

OBJECTIVE: This study sought to evaluate the safety of induction of labour with prostaglandin E2 (PGE2 ) gel in grand multigravida (GMG) women and to compare the labour outcome of GMG women with that of women who never had a previous Caesarean section (CS).

METHODS: This prospective cohort study (Canadian Task Force Classification II-2) evaluated induction of labour with 1 mg of PGE2 gel in 96 GMG women with one previous CS (study group) and in 104 GMG women without previous CS (control group).

RESULTS: One uterine rupture occurred in the study group (1%), and another occurred in the control group (0.9%). Additional oxytocin was used in seven patients (7.3%) in the study group and in 28 others (26.9%) in the control group (P = 0.002). Both uterine ruptures occurred with oxytocin augmentation. One case of uterine scar dehiscence was found in the study group. There was no significant difference between the study group and the control group regarding the rate of vaginal delivery (74 [77.1%] vs. 78 [75%]) or the rate of CS (21 [21.9%] vs. 24 [23.1%]), respectively. There was no significant difference between the groups in 5-minute Apgar scores ≤7. There was no neonatal death in either group.

CONCLUSION: A low dose (1.0 mg) of PGE2 gel for induction of labour in GMG women with one previous CS is appropriate and appears to be safe for both mother and baby. Augmentation by oxytocin should be used judiciously.