Ripening of the uterine cervix in a post-Cesarean parturient: Prostaglandin E₂ versus Foley catheter

Objective: To compare the success and complication rates of prostaglandin E₂ tablets (PGE₂) and a Foley catheter for the ripening of the uterine cervix in post-Cesarean section parturients. Study design: The study population in this retrospective cohort study consisted of parturients in their second pregnancy who had undergone Cesarean section in their previous delivery and who underwent ripening of the uterine cervix by using PGE₂ (n = 55) or Foley catheter (n = 161) in the current pregnancy. The control group consisted of 1432 post-Cesarean section parturients without induction of labor. We compared the rates of placental abruption, non-reassuring fetal heart rate patterns, intrapartum fetal deaths (IPFD), uterine rupture, Apgar scores, labor dystocia, severe birth canal lacerations, vacuum deliveries and repeated Cesarean section rates in the three groups by using ANOVA, χ² analysis and Fisher's exact test when appropriate. Results: A significant increase in the rates of labor dystocia during the first stage (30.4% vs. 11.6%, p < 0.01) and repeated Cesarean deliveries (49.1% vs. 35.2%, p < 0.01) were observed in women in whom the Foley catheter was used as compared to controls, respectively. No such changes were demonstrated in the PGE₂ group as compared to the controls. No significant differences were found between the PGE₂ group and Foley catheter group as compared to the controls in rates of placental abruption, IPFD, uterine rupture, fetal distress, birth canal lacerations, vacuum deliveries and Apgar scores. Conclusions: PGE₂ was found to be superior to the Foley catheter for ripening of the uterine cervix in a post-Cesarean parturient, as demonstrated by a lower repeated Cesarean delivery rate.