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VBAC rupture risk increased with induction
Hmmm...they can widely publicize all sorts of crappy
studies showing increased rupture risk for VBAC, but
they don't seem to bother publicizing studies showing
increased risks with induction.... Here's a new study
showing that pitocin and misoprostol induction for
VBAC increase the rupture rate (though one might
wonder how they defined rupture and how many of the
ruptures caused problems--don't have the whole study
in front of me):
Am J Obstet Gynecol. 2004 May;190(5):1476-8.
Risk of uterine rupture in labor induction of patients with
prior cesarean section: an inner city hospital experience.
Lin C, Raynor BD.
Department of Gynecology and Obstetrics, Emory University at Grady
Healthcare System, Atlanta, GA, USA.
OBJECTIVE: This study was undertaken to determine the risk of uterine
rupture in patients induced with oxytocin or misoprostol after 1 or more
previous cesarean sections. STUDY DESIGN: Patients with 1 or more
previous cesarean sections who delivered after 28 weeks' gestation
between 1996 and 2002 were identified by database. Among 3533 total
patients, rates of uterine rupture were compared among 4 groups:
oxytocin induction (n = 430), misoprostol induction (n = 142),
spontaneous labor (n = 2523), and repeat cesarean section without labor
(n = 438). Statistical analysis included chi(2) test, Fisher exact test,
unpaired t test, and Mantel-Haenszel test. RESULTS: Rate of rupture was
increased in all inductions compared with that of the spontaneous labor
group. Among patients with 1 prior cesarean, rupture rates with
misoprostol and oxytocin induction were 0.8% and 1.1%, respectively.
CONCLUSION: Induction of labor with oxytocin or misoprostol is
associated with a higher rate of uterine rupture compared with those who
deliver after spontaneous labor. After 1 prior cesarean, rupture rate
with misoprostol induction is not increased compared with oxytocin
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