A recent retrospective review of hospital discharge data found what appeared to be a marked increase in uterine rupture rates when prostaglandins were used for cervical ripening in vaginal birth after cesarean (VBAC) patients.¹ However, the study had serious limitations that were appropriately acknowledged by its authors and subsequently reviewed in a published critique.² In spite of the study’s limitations, the American College of Obstetrics and Gynecology (ACOG) responded by publishing a Committee Opinion stating that, “The purpose of this document is to discourage the use of prostaglandins for cervical ripening or the induction of labor in women attempting VBAC.³ This opinion will no doubt be controversial because both a large multicenter study and a review of many smaller studies did not find any increased risk with prostaglandin use in VBAC patients.^4,5

1. Lydon-Rochelle M, Holt V, Easterling T: Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med 345:3, 2001

2. Flamm B: Vaginal birth after cesarean and the NEJM: A strange controversy. Birth 28:276, 2001

3. ACOG Committee on Obstetric Practice: Induction of labor for vaginal birth after cesarean delivery: ACOG Committee Opinion Number 271. Obstet Gynecol 99:679, 2002

4. Phelan J: VBAC: Time to reconsider? OBG Manage 11:62, 1996

5. Flamm B, Anton D, Goings J, et al: Prostaglandin E2 for cervical ripening: A multicenter study of patients with prior cesarean delivery. Am J. Perinatol 14:157, 1997