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Outcome of IOL with propess in previous caesarean section
  1. N Aslam,
  2. S Ghatak,
  3. A Mulay,
  4. S Sharma
  1. Walsall Manor Hospital, Birmingham, UK

Abstract

Background Caesarean birth accounts for 24.6% of births in UK. Incidence of uterine disruption is two- to threefold greater with induction of labour (IOL) than with spontaneous labour (0.89% vs 0.36%) with 1.5-fold increase in the risk of Caesarean section. IOL with prostaglandin E2 is associated with further increase in risk of rupture 1.4% and increase in risk perinatal death (0.1% vs 04%).

Aim To evaluate the maternal and fetal outcome of IOL with propess in women with previous Caesarean section.

Methods A retrospective review over period of 3 years.

Results 58 patients had propess after one previous Caesarean section. Indications for IOL were Postdate 25%, IUGR 15%, PET 15%, Prolong SROM 13% and GDM 5%.

Only 50% had appropriate counselling re vaginal birth after Caesarean (VBAC). Bishop score was <5 in 86%. 30% had subsequent augmentation with syntocinon. Induction to delivery interval was mean 91.96 h (range 4–56 h). 70% (21/30) delivered within 24 h and 30% within 48 h. 49% (30/58) achieved vaginal delivery including four instrumental deliveries. 48% (28/58) had LSCS lower segment Caesarean section, 35% for fetal distress, 28% failure to progress, 6% for suspected scar dehiscence and 14% for failed IOL.

Maternal/Neonatal outcome: 5% (3/58) had hyperstimulation, 2% (1/58) postpartum haemorrhage (PPH) and 2% (1/58) had scar dehiscence. 3/58 (5.1%) babies required admission to neonatal unit.

Conclusion Propess is safe and effective in patients with previous Caesarean section, does not induce adverse maternal or fetal morbidity and achieved vaginal delivery in at least 50%. However appropriate patient counselling, careful patient selection and decision re IOL and further management plan at consultant level is mandatory.

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