Objectives Worldwide, the overall cesarean section is rising. Trial of labor after cesarean (TOLAC) is an overall safe option with an immediate impact on neonatal and maternal short- and long-term health. Since the use of prostaglandins in cervical ripening is associated with an increased risk of uterine rupture, mechanical methods as balloon catheters or osmotic dilators have been suggested for cervical ripening prior to induction of labour. Here we are analyzing and comparing the VBAC rate, as well as maternal and fetal outcome in cervical ripening prior to TOLAC. Methods This prospective dual center study analyses maternal and neonatal outcomes of TOLAC in women with an unfavorable cervix requiring cervical ripening agent. The prospective application of an osmotic dilator (Dilapan-S, n=104) was analysed in comparison to the retrospective application of off-label dinoprostone (n=102). Results The overall fetal and neonatal outcome revealed no significant differences in both groups. Patients receiving cervical ripening with the osmotic dilator delivered vaginally/by ventouse in 52% of cases, compared to 53% when using dinoprostone (p=0.603). The interval between application to onset of labor was significantly higher in the osmotic dilator group (37.9 vs.20.7 h, p=<0.001). However, time from onset of labor to delivery was similar in both groups (7.93 vs. 7.44 h, p=0.758). There was one case of uterine rupture in the dinoprostone group. Conclusions Our data shows that the application of the osmotic dilator leads to similar outcomes in VBAC rate and time from onset of labor to delivery as well as safety in both groups compared to off-label use dinoprostone. Cervical ripening using the mechanical dilator is a viable and effective option, without the risk of uterine hyperstimulation.

中文翻译：

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剖宫产后宫颈成熟：一项比较机械渗透扩张器与前列腺素 E2 的前瞻性双中心研究

目标 在全球范围内，剖宫产手术的数量正在上升。剖宫产后试产 (TOLAC) 是一种整体安全的选择，对新生儿和产妇的短期和长期健康有直接影响。由于在宫颈成熟过程中使用前列腺素会增加子宫破裂的风险，因此建议在引产前使用球囊导管或渗透扩张器等机械方法进行宫颈成熟。在这里，我们正在分析和比较 VBAC 率，以及在 TOLAC 之前宫颈成熟的母胎结局。方法 这项前瞻性双中心研究分析了 TOLAC 对需要宫颈成熟剂的宫颈不利的女性的母婴结局。渗透扩张器（Dilapan-S，n = 104）与标签外地诺前列酮（n = 102）的回顾性应用相比进行了分析。结果 两组胎儿和新生儿的总体结局没有显着差异。在 52% 的病例中，使用渗透扩张器接受宫颈成熟的患者有 52% 的病例，而使用地诺前列酮的病例为 53% (p=0.603)。渗透扩张剂组应用到分娩开始的时间间隔显着延长（37.9 vs.20.7 h，p=<0.001）。然而，两组从分娩开始到分娩的时间相似（7.93 对 7.44 小时，p=0.758）。地诺前列酮组子宫破裂1例。结论 我们的数据显示，与标签外使用地诺前列酮相比，渗透扩张器的应用导致两组的 VBAC 率和从分娩开始到分娩的时间以及安全性相似。使用机械扩张器进行宫颈成熟是一种可行且有效的选择，没有子宫过度刺激的风险。