Prostaglandin E(2) for cervical ripening: A multicenter study of patients with prior cesarean delivery

To evaluate the maternal and fetal outcomes of a large cohort of women treated with prostaglandin E(2) (PGE(2)) gel for cervical ripening prior to trial of labor after previous cesarean delivery. Beginning in 1990 all pregnant patients with previous cesarean delivery presenting for prenatal care at 10 California hospitals were prospectively studied. We analyzed multiple parameters to compare outcomes of cases in which PGE(2) gel was used to outcomes in a control group in which PGE(2) was not used. Data were examined by X(2) testing. During the study period 5022 patients underwent trial of labor after prior cesarean delivery. Of these 5022 patients, 453 (9%) were treated with PGE(2) gel. There was no significant difference in the incidence of uterine rupture between the PGE(2) group and the control group. Indicators of maternal and perinatal morbidity were not significantly higher in the prostaglandin treated group. The use of PGE(2) gel for cervical ripening appears to be relatively safe in patients with prior cesarean delivery.