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Pregnancy outcomes of induction of labor with metreurynter at or after 39 weeks of gestation in women with one previous cesarean delivery.

Kento Misawa, Yoshiaki Maseki, Atsuko Tezuka, Madoka Furuhashi1

Objective: To elucidate the efficacy of induction of labor with metreurynter for women with one previous cesarean delivery. Methods: A database was reviewed to identify women with singleton and vertex pregnancies who underwent trial of labor after one cesarean delivery (TOLAC) at or after 39 weeks of gestation between the years 2010 and 2016. Results: Fifty-one women underwent induction of labor with metreurynter, and 230 women had spontaneous onset of labor pain. Successful TOLAC was observed in 95.2% (219/230) and 74.5% (38/51) of women with spontaneous onset of labor pain and induction, respectively (p<0.001). A case of uterine rupture was seen in a woman with induction, where the baby was born dead by cesarean section. Multivariable analysis demonstrated that induction of labor was an independent risk factor for successful TOLAC (adjusted odds ratio 0.21 and 95% confidence interval 0.07-0.65). Vacuum extraction (23.7% vs 6.8%, p<0.001) and amniotomy (55.3% vs 33.3%, p=0.010) were more frequent in women who had successful TOLAC with induction than those with spontaneous onset of labor. Conclusion: Induction of labor with metreurynter decreases the success of TOLAC but is satisfactory in clinical practice based on its success rate. Induction of labor should be an option in women with TOLAC and no labor pain.