Comparison of Induction of Labor Methods for Unfavorable Cervices in Trial of Labor After Cesarean Delivery [27J]

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To compare induction of labor methods with the Cook balloon versus oxytocin in patients attempting a trial of labor after cesarean delivery with an unfavorable cervix.


This is a retrospective cohort study from patients attempting trial of labor after cesarean from 2009–2013 at one institution. Patients with a simplified Bishop score of three or less where labor was initiated with either Cook balloon or oxytocin alone were included. Our primary outcome was mode of delivery of vaginal delivery versus repeat cesarean delivery. Our secondary outcomes included duration of labor and multiple maternal and neonatal morbidities.


214 women met inclusion criteria, of which 150 received oxytocin for induction and 64 had the Cook balloon placed. The vaginal birth after cesarean delivery rate was significantly higher in the oxytocin group at 70.7% versus 50.0% in the Cook balloon group (P=.004). This difference remained significant in the multivariable analysis where odds for cesarean delivery were two times higher with the Cook balloon than with oxytocin induction (Adjusted OR=2.09, 95% CI=1.05–4.18, P=.036). The duration of labor was significantly longer with the Cook balloon versus oxytocin induction (21.9 versus 16.3 hours, P=.0002). There were no significant differences in uterine rupture or maternal and neonatal health outcomes between the two groups.


Oxytocin induction of labor was associated with a higher rate of vaginal delivery and a shorter duration of labor as compared to the Cook balloon in women undergoing trial of labor after cesarean with an unfavorable cervix.

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