Do Different Modes of Labor Induction Affect the Overall Success and Risk of Trial of Labor After Cesarean Section?

OBJECTIVE: To determine whether different modes of labor induction impact the success rate and perinatal morbidity in women undergoing trial of labor after cesarean (TOLAC). STUDY DESIGN: Retrospective review of the Consortium on Safe Labor electronic database from 2002�2008; women with a prior cesarean birth, desiring TOLAC, and requiring induction of labor were included. Oxytocin and Foley bulb induction methods were compared to amniotomy alone. Prostaglandin use was also reviewed but, given the small numbers, was not the focus of this study. RESULTS: Univariate analysis showed significantly greater incidence of hemorrhage >1,000 mL (p=0.0030) and transfusion (p=0.0076) with Foley bulb use. All methods of induction for TOLAC decreased repeat cesarean sections (OR 0.34, 95% CI 0.23�0.52, p<0.01). CONCLUSION: Induction of labor does not alter the success rate for TOLAC candidates, regardless of mode of induction. When choosing induction methods, one should be mindful of the apparent additional risk of increased blood loss and transfusion with intracervical Foley bulb usage.