Obstetric outcomes associated with induction of labor after 2 prior cesarean deliveries

OBJECTIVE: We sought to determine whether, in the setting of induction, obstetric outcomes differ based on the number of prior cesarean deliveries (CD) and to determine whether women with 2 cesareans undergoing induction face increased risks of adverse outcomes compared to women undergoing a repeat CD. STUDY DESIGN: This is a secondary analysis of a 4-year multicenter prospective cohort. Women with 1 or 2 CD were included. Frequencies of vaginal birth after cesarean as well as maternal and neonatal complications were compared among women with 1 CD undergoing induction, women with 2 CD undergoing induction, and women undergoing repeat CD with 2 cesareans. RESULTS: Of the 10,262 women included in this study, 4100 (40.0%) underwent an induction after 1 CD, 152 (1.5%) underwent an induction after 2 CD, and 6010 (58.6%) had a repeat CD after 2 CD. In women undergoing induction, the chance of vaginal birth after cesarean was no different in women with 2 compared to 1 prior CD (65% vs 69%, P = .28). Similarly, composite maternal (adjusted odds ratio [aOR], 1.2; 95% confidence interval [CI], 0.6-2.3) and neonatal (aOR, 1.1; 95% CI, 0.7-1.7) outcomes were not different between the 2 groups. In women who had 2 prior CD, undergoing an induction carried similar composite adverse maternal and neonatal outcomes compared to having a repeat CD (aOR, 0.7; 95% CI, 0.3-2.0; aOR, 1.1; 95% CI, 0.6-2.2). CONCLUSION: Labor induction outcomes are similar regardless of whether women have had 1 or 2 CD. After 2 CD, undergoing an induction carries similar maternal and neonatal risks as having a repeat CD.