Abstract
Author(s): ADAM CIEMINSKI
Introduction. The principal problem with pregnancy and labor after prior cesarean section is the fear for rupture in cicatrix after this procedure. In this group of women there are many controversies related to the active management of labor such as: pharmacological induction and augmentation. Usage of those methods is caused by an increased risk of uterine rupture. Aim of the study. The analysis of success and safety of spontaneous birth attempt in a group of women with a history of a single low transverse uterine incision c-section in whom active procedures were undertaken, involving induced and facilitated delivery. Materials end methods. We retrospectively reviewed the medical records of 222 women undergoing oxytocin end misoprostol induction and/or augmentation of labor in group of 492 women with one previous low transverse acesarean delivery attempting vaginal birth during the period from 1992-2002 at Hospital in Chojnice. The aim of this study was to asses safty and efficace of active managmant of labor including induction and augmentation in women with prior cesarean section.Statistical comparisons were performed using test Z. Statisticeal significance was defined as p<0.05. Results. Active managment was performed in 222 women with 75,7% rate of success versus 90,7% in the group of 270 women with spontaneous labor. The rate of success in women with induction of labor by oxytocin (62,7%) and misoprostol (70%) was significant lower compared with women with spontaneus onset of labor (success 64,6%). Women treated with oxytocin were more likely to delivery vagianaly when oxytocin was used by augmentation (87,2%) than by induction (62,7%). Women with cervical dilation greater than 3cm at the time of induction by oxytocin were more likely to have success of trial of labor. There were no cases of uterine rupture. Conclusions. Induction and augmentation of labor by oxytocin in women with one prior low transverse cesarean delivery is not contraindicated. An active managmant of labor including induction and augmentation is associated with a decrease rate of success particulary, when oxytocin is used for induction than for augmentation. Women andergoing induction with oxytocin are more likely to have a higher rate of vaginal delivery when dilation of cervix is greater than 3cm