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

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.

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).

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.

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.