Double-balloon catheter and sequential vaginal prostaglandin E2 versus vaginal prostaglandin E2 alone for induction of labor after previous cesarean section.
PURPOSE
To evaluate the efficacy of inducing labor using a double-balloon catheter and vaginal prostaglandin E2 (PGE2) sequentially, in comparison with vaginal PGE2 alone after previous cesarean section.


METHODS
A total of 264 pregnant women with previous cesarean section undergoing labor induction at term were included in this prospective multicentre cohort study. Induction of labor was performed either by vaginal PGE2 gel or double-balloon catheter followed by vaginal PGE2. The primary outcome measure was the cesarean section rate.


RESULTS
The cesarean section rate was 37 % without any statistically significant difference between the two groups (PGE2: n = 41, 37 % vs. balloon catheter/PGE2: n = 41, 42 %; P = 0.438). The median (range) number of applications of PGE2 [2 (1-10) versus 1 (0-8), P < 0.001] and the total amount of PGE2 used in median (range) mg [2 (1-15) vs. 1 (0-14), P = 0.001] was less in the balloon catheter/PGE2 group. Factors significantly increasing risk for cesarean section were "no previous vaginal delivery" (OR 5.391; CI 2.671-10.882) and "no oxytocin augmentation during childbirth" (OR 2.119; CI 1.215-3.695).


CONCLUSIONS
The sequential application of double-balloon catheter and vaginal PGE2 is as effective as the sole use of vaginal PGE2 with less applications and total amount of PGE2.
['Kehl|Sven|S|', 'Weiss|Christel|C|', 'Wamsler|Michael|M|', 'Beyer|Jana|J|', 'Dammer|Ulf|U|', 'Heimrich|Jutta|J|', 'Faschingbauer|Florian|F|', 'Sütterlin|Marc|M|', 'Beckmann|Matthias W|MW|', 'Schleussner|Ekkehard|E|']
D000282:Administration, Intravaginal D000328:Adult D002404:Catheterization D057785:Catheters D002584:Cervix Uteri D002585:Cesarean Section D036861:Delivery, Obstetric D015232:Dinoprostone D005260:Female D006801:Humans D007751:Labor, Induced D007743:Labor, Obstetric D010120:Oxytocics D010121:Oxytocin D011247:Pregnancy D011446:Prospective Studies D016896:Treatment Outcome D016064:Vaginal Birth after Cesarean
Double-balloon catheter Prostaglandin E2 Induction of labor Previous cesarean section Dinoprostone Scarred uterus