+For patients with a previous C-section delivery, labour induction is considered to be risky, due to higher rates of uterine scar rupture, 2.5% when induced with prostaglandins, 0.7% when induced with non-prostaglandins, and 0.5% when labour is spontaneous. However, labour induction is done in 27-32.7% of those who try for a vaginal birth after C-section (VBAC), and is accepted in high-resource settings with informed patient consent. For an unriped cervix, Foley catheter balloon and controlled release dinoprostone vaginal inserts are two methods of inducing labour, and a 2018 systematic review found no differences in safety or effectiveness for patients without a prior C-section. Therefore, this current randomized controlled trial compared the time to delivery and satisfaction outcomes for these two labour induction techniques, among patients with one prior C-section. The study population consisted of 78 women, with 39 randomized to each treatment group. Each participant had a Bishop Score of 5 or less, intact membranes, and no more than 2 contractions in 10 minutes. The results showed that the induction to delivery time was 10 hours longer in the Foley catheter group than the dinoprostone group, with a median [IQR] interval of 33.5 [26.1-36.2] and 23.5 [12.7-34.5] hours respectively (p = 0.004). As well, there were no differences in maternal satisfaction on the 100-point visual analog scale, with a median score of 80 [64-88] and 82 [67-88] for the Foley catheter and dinoprostone respectively. There were also no uterine ruptures in the trial (95% CI 0-5.6%). Overall, this study showed that for patients with one prior C-section, time to delivery following controlled release dinoprostone labour induction was significantly quicker compared to the use of a Foley catheter balloon, although no differences in satisfaction were found.
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