{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T19:28:03Z","timestamp":1780514883301,"version":"3.54.1"},"reference-count":41,"publisher":"Walter de Gruyter GmbH","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_jpm-2021-0157_abs_001\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpm-2021-0157_abs_002\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpm-2021-0157_abs_003\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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\u00a0h, p=&lt;0.001). However, time from onset of labor to delivery was similar in both groups (7.93 vs. 7.44\u00a0h, p=0.758). There was one case of uterine rupture in the dinoprostone group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpm-2021-0157_abs_004\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/jpm-2021-0157","type":"journal-article","created":{"date-parts":[[2021,8,1]],"date-time":"2021-08-01T20:05:32Z","timestamp":1627848332000},"page":"797-805","source":"Crossref","is-referenced-by-count":9,"title":["Cervical ripening after cesarean section: a prospective dual center study comparing a mechanical osmotic dilator vs. prostaglandin E2"],"prefix":"10.1515","volume":"49","author":[{"given":"Josefine Theresia","family":"Koenigbauer","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology , Vivantes Klinikum im Friedrichshain, Affiliate of Charit\u00e9 University , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Schalinski","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Vivantes Klinikum im Friedrichshain, Affiliate of Charit\u00e9 University , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ute","family":"Jarchau","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Vivantes Klinikum im Friedrichshain, Affiliate of Charit\u00e9 University , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Gauger","sequence":"additional","affiliation":[{"name":"Institute of Medical Statistics , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrin","family":"Brandt","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Sana Klinikum Lichtenberg , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Klaucke","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Sana Klinikum Lichtenberg , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens-Peter","family":"Scharf","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Sana Klinikum Lichtenberg , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Werner","family":"Rath","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , University of Aachen , Aachen , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Hellmeyer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Vivantes Klinikum im Friedrichshain, Affiliate of Charit\u00e9 University , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2021,8,2]]},"reference":[{"key":"2023040100292410050_j_jpm-2021-0157_ref_001","unstructured":"Federal Statistical Office Germany: hospital deliveries in Germany. 2020."},{"key":"2023040100292410050_j_jpm-2021-0157_ref_002","unstructured":"Health at a Glance 2019. 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