Artificial Induction of Labour in Patients with Scarred Uterus: A Case-Control Study Evaluating the Efficacy and Safety of Misoprostol and the Balloon in Two Maternity Units in Dakar
Objective: To evaluate the efficacy and safety of misoprostol and the balloon catheter in inducing labour in this context. Methodology: This is a bi-centric case-control study nested within a descriptive and analytical cohort over a period of 32 months from 1 January 2021 to 31 August 2024. The methods used to induce labour were the balloon catheter and misoprostol, based on FIGO recommendations. Results: During the study period, 3330 deliveries on scarred uterus were recorded in the two hospitals. Among these patients, 1064 met the inclusion criteria and 69 patients had artificially induced labour. The proportion of artificial induction of labour on scarred uterus was 5.92%. The balloon was the most commonly used method of induction (55.1%). The Bishop score was considered unfavourable (below 7) in almost all cases (99.7%). Among the indications for induction, the most common was foetal death in utero, with a frequency of 18.8%. Hypertensive disorders and post-term or prolonged pregnancy were noted, with similar prevalences of 17.4%. Premature rupture of membranes was the fourth most common indication, observed in 10.1% of cases. Regarding the effectiveness of labour induction, the duration of labour is significantly longer in cases of labour induction. Vaginal delivery was more common in cases of spontaneous labour induction: prevalence rates of 66.8% were noted for spontaneous induction and 53.6% for artificial induction. Misoprostol was associated with 67.7% of vaginal deliveries and the balloon with 42.1%: p = 0.034; OR 2.89 [1.07; 7.78]. There was a tendency towards more perinatal asphyxia in the spontaneous labour induction group. Conclusion: With careful patient selection and controlled indications, induction of labor remains a highly recommended method for reducing repeat caesarean section rates while minimising foetal and maternal risks.
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