Induction of Labor with Vaginal Dinoprostone (PGE2) in Patients with a Previous Cesarean Section: Obstetric and Neonatal Outcomes

Background: Vaginal dinoprostone (PGE2) is currently used as the prostaglandin of choice in many obstetric units. However, few studies have evaluated its safety, especially in women who previously had a cesarean section. Objective: To evaluate the efficacy and safety of PGE2 in pregnant women who are undergoing induction of labor (IOL), and who have had a previous cesarean section. Materials and Methods: A prospective observational study was conducted in La Mancha Centro Hospital in Alcázar de San Juan, Spain, from 1 February 2019 to 30 August 2020. Obstetric and neonatal outcomes, following IOL with PGE2, in 47 pregnant women who wanted a trial of labor after cesarean (TOLAC), and 377 pregnant women without a history of cesarean section, were analyzed. The outcomes were analyzed by bivariate and multivariate analyses using binary and multiple linear regression. Results: A total of 424 women were included in this study. The percentage of cesarean sections in the TOLAC group was 44.7% (21), compared with 31.6% (119) in the group without a history of cesarean section (adjusted odds ratio: 1.4; 95% CI: 0.68–2.86). In the multivariate analysis, no statistically significant differences were observed between both groups for obstetric and neonatal outcomes (p > 0.05). However, two uterine ruptures (4.3%) occurred in the group of patients with a history of cesarean section who underwent IOL with PGE2. Conclusions: The induction of labor with vaginal dinoprostone (PGE2), in patients with a previous history of cesarean section, was not associated with worse obstetric or neonatal outcomes compared with the group of patients without a history of cesarean section in our study sample. However, further research is needed regarding this IOL method, and it should be used with caution in this population group.

Conducción del trabajo de parto en gestantes con cesárea previa en el Hospital Central Universitario Dr. Jesús María Casal Ramos. Acarigua-Estado Portuguesa.

Objective: To estimate the safety of vaginal delivery in pregnant women at term in spontaneous labor with previous cesarean section who attended the Obstetric Emergency Service of the Dr. Jesús María Casal Ramos University Hospital, in the period January-June 2018. Methods: A prospective, descriptive, cross-sectional and non-causal correlational study was conducted in pregnant women at term with a previous caesarean section in labour. The medical records of full-term pregnant women who entered into spontaneous labor and who underwent conduction of labor were reviewed if the indication for cesarean section did not persist, recording maternal, fetal and neonatal complications. Results: We attended 245 pregnant women, with previous cesarean section, 108 patients were included of which 99 (92 %) did not present complications and of the remaining nine, 4 (44 %) presented grade I tear, 4 (44 %) grade II tear and only 1 (12 %) grade III tear. The most frequent anatomical location was vaginal in 6 (67 %), cervical in 3 (33 %); the size of the same was not described; the grade III vaginal tear was sutured, did not require blood transfusion and the product weighed 4000 kg. There were no maternal deaths or fetal complications or fetal deaths. Conclusions: Spontaneously initiated vaginal delivery in pregnant women with previous caesarean section is 92% safe. Keywords: Vaginal Birth, Prior caesarean, Interpartum interval, Labor conduction.

Clinical Experience Over 15 Years with the B-Lynch Compression Suture Technique in the Management of Postpartum Hemorrhage

Objective To describe the clinical experience with the B-Lynch technique in the management of postpartum hemorrhage as well as the factors related to the indication of the technique and to present the success rates of the application of the B-Lynch technique. Methods Observational, retrospective, cross-sectional, and analytical study. Patient data was obtained through the study of medical records. The study population comprised of patients who underwent hemostatic suture using the B-Lynch technique, including 104 patients within the period from January 1, 2005, to December 31, 2019. Results Of the total of 104 patients, 82.7% did not present any complications. Blood transfusion and intensive care unit admission were the most prevalent complications, with 13.5% and 15.4%, respectively. Only 1% of the patients had puerperal and surgical site infections. The factors most related to the application of the technique were the presence of previous cesarean section (30.8%), use of oxytocin (16.3%), and preeclampsia (11.6%). Puerperal hysterectomy was performed in 4.8% of the patients due to failure of the method. Conclusion The clinical experience with the B-Lynch technique was satisfactory since it presented few complications, with excellent results in hemorrhagic control. Previous cesarean section, the use of oxytocin, and preeclampsia stood out as factors related to the indication of the application of the technique, and the success rate in controlling postpartum hemorrhage was 95.2%.