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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 induction. |
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