Cervical ripening after cesarean section: a prospective dual center study comparing a mechanical osmotic dilator vs. prostaglandin E2

Journal of Perinatal Medicine, vol. 49, pp. 797–805

Abstract

OBJECTIVES: Worldwide, the overall cesarean section is rising. Trial of labor after cesarean (TOLAC) is an overall safe option with an immediate impact on neonatal and maternal short- and long-term health. Since the use of prostaglandins in cervical ripening is associated with an increased risk of uterine rupture, mechanical methods as balloon catheters or osmotic dilators have been suggested for cervical ripening prior to induction of labour. Here we are analyzing and comparing the VBAC rate, as well as maternal and fetal outcome in cervical ripening prior to TOLAC. METHODS: This prospective dual center study analyses maternal and neonatal outcomes of TOLAC in women with an unfavorable cervix requiring cervical ripening agent. The prospective application of an osmotic dilator (Dilapan-S, n=104) was analysed in comparison to the retrospective application of off-label dinoprostone (n=102). RESULTS: The overall fetal and neonatal outcome revealed no significant differences in both groups. Patients receiving cervical ripening with the osmotic dilator delivered vaginally/by ventouse in 52% of cases, compared to 53% when using dinoprostone (p=0.603). The interval between application to onset of labor was significantly higher in the osmotic dilator group (37.9 vs.20.7 h, p=<0.001). However, time from onset of labor to delivery was similar in both groups (7.93 vs. 7.44 h, p=0.758). There was one case of uterine rupture in the dinoprostone group. CONCLUSIONS: Our data shows that the application of the osmotic dilator leads to similar outcomes in VBAC rate and time from onset of labor to delivery as well as safety in both groups compared to off-label use dinoprostone. Cervical ripening using the mechanical dilator is a viable and effective option, without the risk of uterine hyperstimulation.

Authors 9

1. Josefine Theresia Königbauer corresponding

   Charité - Universitätsmedizin Berlin · Klinikum im Friedrichshain

   Affiliation as printed

   Department of Obstetrics and Gynecology , Vivantes Klinikum im Friedrichshain, Affiliate of Charité University , Berlin , Germany

2. Elisabeth Schalinski

   Charité - Universitätsmedizin Berlin · Klinikum im Friedrichshain

   Affiliation as printed

   Department of Obstetrics and Gynecology , Vivantes Klinikum im Friedrichshain, Affiliate of Charité University , Berlin , Germany

3. Ute Jarchau

   Charité - Universitätsmedizin Berlin · Klinikum im Friedrichshain

   Affiliation as printed

   Department of Obstetrics and Gynecology , Vivantes Klinikum im Friedrichshain, Affiliate of Charité University , Berlin , Germany

4. Ulrich Gauger
   Affiliation as printed

   Institute of Medical Statistics , Berlin , Germany

5. K Brandt

   Sana Klinikum Lichtenberg

   Affiliation as printed

   Department of Obstetrics and Gynecology , Sana Klinikum Lichtenberg , Berlin , Germany

6. Sandra Klaucke

   Sana Klinikum Lichtenberg

   Affiliation as printed

   Department of Obstetrics and Gynecology , Sana Klinikum Lichtenberg , Berlin , Germany

7. Jens-Peter Scharf

   Sana Klinikum Lichtenberg

   Affiliation as printed

   Department of Obstetrics and Gynecology , Sana Klinikum Lichtenberg , Berlin , Germany

8. Werner H. Rath Aachen Department of Obstetrics and Gynecology

   RWTH Aachen University

   Affiliation as printed

   Department of Obstetrics and Gynecology , University of Aachen , Aachen , Germany

9. L Hellmeyer

   Charité - Universitätsmedizin Berlin · Klinikum im Friedrichshain

   Affiliation as printed

   Department of Obstetrics and Gynecology , Vivantes Klinikum im Friedrichshain, Affiliate of Charité University , Berlin , Germany