What type of cervical ripening method is associated with higher risks during TOLAC?

Prostaglandin cervical ripening is associated with higher risks during trial of labor after cesarean (TOLAC) due to the potential for uterine hyperstimulation and its effects on the uterine scar. Prostaglandins, such as misoprostol, can lead to increased uterine contractions, which may result in an increased risk of uterine rupture in women with a previous cesarean delivery, especially if there is a pre-existing uterine scar. The use of these agents requires careful monitoring because the stimulation of the uterus does not allow for controlled contractions, which can be dangerous in a TOLAC scenario.

Mechanical dilation, oxytocin use, and amniotomy can have their own risks but are typically more controlled and may be less likely to cause significant harm in TOLAC compared to prostaglandins. Mechanical methods do not involve medication that causes active contraction of the uterus, and oxytocin is generally used after some degree of cervical ripening has occurred and can be moderated. Amniotomy, while it can introduce risks such as infection or umbilical cord prolapse, offers the advantage of reducing the likelihood of uterine hypertonicity. Thus, the inherent risks associated with prostaglandin