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Am Fam Physician. 2007;75(6):931

ACOG Releases Opinion on Inducing Labor for VBAC

There is a continued debate regarding whether the induction of labor with or without prostaglandins increases the risk of uterine rupture during labor. For this reason, a committee of the American College of Obstetricians and Gynecologists (ACOG) has released an updated opinion on inducing labor for vaginal birth after cesarean delivery (VBAC). The statement was published in the August 2006 issue of Obstetrics & Gynecology.

Several studies have shown an increased risk of uterine rupture after induction of labor in women who have had a previous cesarean delivery. One population-based retrospective cohort study of more than 20,000 women who had a previous cesarean delivery found that the rate of uterine rupture was 0.16 percent in those who had another cesarean delivery, 0.52 percent in those who had spontaneous labor, 0.77 percent in those with induction of labor without prostaglandins, and 2.4 percent in those with induction of labor with prostaglandins. Two larger trials of women with previous cesarean delivery found that uterine rupture was more likely to occur when labor was augmented or induced. Several studies also found that the uterine rupture rate was significantly lower in women who had successful trials of labor compared with those who had failed trials of labor (0.01 percent and 2.0 to 2.3 percent, respectively).

A review of these studies indicates that rates of uterine rupture are increased when labor is induced and prostaglandins and oxytocin (Pitocin) are used. However, the most consistently increased rates of uterine rupture occur in failed trials of labor. Labor induction is a reasonable option, and it may be necessary in patients with VBAC. By choosing women who are most likely to give birth vaginally and avoiding the repeated use of prostaglandins and oxytocin, risk of uterine rupture can be reduced. Still, the risk of uterine rupture should be discussed with the patient and documented in the medical record.

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