An audit about labour induction, using prostaglandin, in women with a scarred uterus

Correlation Between Previous Caesarean Section and Adverse Maternal Outcomes Accordingly With Robson Classification: Systematic Review and Meta-Analysis

Background: The increasing rates of Caesarean section (CS) beyond the WHO standards (10–15%) pose a significant global health concern.

Objective: Systematic review and meta-analysis to identify an association between CS history and maternal adverse outcomes for the subsequent pregnancy and delivery among women classified in Robson classification (RC).

Search Strategy: PubMed/Medline, EbscoHost, ProQuest, Embase, Web of Science, BIOSIS, MEDLINE, and Russian Science Citation Index databases were searched from 2008 to 2018.

Selection Criteria: Based on Robson classification, studies reporting one or more of the 14 adverse maternal outcomes were considered eligible for this review.

Data Collection: Study design data, interventions used, CS history, and adverse maternal outcomes were extracted.

Main Results: From 4,084 studies, 28 (n = 1,524,695 women) met the inclusion criteria. RC group 5 showed the highest proportion among deliveries followed by RC10, RC7, and RC8 (67.71, 32.27, 0.02, and 0.001%). Among adverse maternal outcomes, hysterectomy had the highest association after preterm delivery OR = 3.39 (95% CI 1.56–7.36), followed by Severe Maternal Outcomes OR = 2.95 (95% CI 1.00–8.67). We identified over one and a half million pregnant women, of whom the majority were found to belong to RC group 5.

Conclusions: Previous CS was observed to be associated with adverse maternal outcomes for the subsequent pregnancies. CS rates need to be monitored given the prospective risks which may occur for maternal and child health in subsequent births.

Prevalence of uterine rupture among women with one prior low transverse cesarean and women with unscarred uterus undergoing labor induction with PGE2: A systematic review and meta-analysis

BACKGROUND

As uterine rupture may affect as many as 11/1000 women with 1 prior cesarean birth and 5/10.000 women with unscarred uterus undergoing labor induction, we intended to estimate the prevalence of such rare outcome when PGE2 is used for cervical ripening and labor induction.

METHODS

We searched MEDLINE, ClinicalTrials.gov and the Cochrane library up to September 1st 2020. Retrospective and prospective cohort studies, as well as randomized controlled trials (RCTs) on singleton viable pregnancies receiving PGE2 for cervical ripening and labor induction were reviewed. Prevalence of uterine rupture was meta-analyzed with Freeman-Tukey double arcsine transformation among women with 1 prior low transverse cesarean section and women with unscarred uterus.

RESULTS

We reviewed 956 full text articles to include 69 studies. The pooled prevalence rate of uterine rupture is estimated to range between 2 and 9 out of 1000 women with 1 prior low transverse cesarean (5/1000; 95%CI 2-9/1000, 122/9000). The prevalence of uterine rupture among women with unscarred uterus is extremely low, reaching at most 0.7/100.000 (<1/100.000.000; 95%CI <1/100.000.000-0.7/100.000, 8/17.684).

CONCLUSIONS

Uterine rupture is a rare event during cervical ripening and labor induction with PGE2.

Induction of Labour With Prostaglandin Gel in Grand Multipara with a Previous Caesarean Delivery

OBJECTIVE

This study sought to evaluate the safety of induction of labour with prostaglandin E₂ (PGE₂) gel in grand multiparous (GMP) women and to compare the labour outcome of GMP women who have undergone one previous Caesarean section (CS) with that of GMP women who never had a previous CS.

METHODS

This prospective cohort study (Canadian Task Force Classification II-2) evaluated induction of labour with 1 mg of PGE₂ gel in 96 GMP women with one previous CS (study group) and in 104 GMP 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 GMP women with one previous CS is appropriate and appears to be safe for both mother and baby. Augmentation by oxytocin should be used judiciously.

Analysis of the efficacy of resveratrol treatment in patients with scarred uterus

Scarred uterus is caused by cesarean section surgery, and this condition affects further gestation and delivery in patients. Previous evidence suggested that resveratrol, a polyphenol compound, presents beneficial outcomes for patients with scarred uterus. Therefore, the aim of the present study was to analyze the efficacy of resveratrol in the treatment of patients with scarred uterus. The efficacy of resveratrol in the formation of new vessels and re-epithelialization of the endometrium was analyzed. The present results demonstrated that resveratrol treatment reduced uterus scarring in the majority of patients (87.36%) compared with the control. It was also observed that the plasma levels of β-human chorionic gonadotropin were downregulated by resveratrol treatment in patients with scarred uterus. Furthermore, resveratrol treatment promoted the remodeling of the scarred uterus, the regeneration of the endometrium and improved pregnancy outcomes. In conclusion, the findings of the current study indicate that resveratrol treatment may be a potential strategy for the treatment of scarred uterus patients, which contributes to the improvement of pregnancy outcomes.