Is Early Amniotomy Associated with Higher Likelihood of Vaginal Birth after Cesarean?

Varvoutis, Megan; Sayres, Lauren; Dotters‐Katz, Sarah K.

doi:10.1055/s-0040-1702924

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…A recently published case–control secondary analysis of the MFMU (Maternal–Fetal Medicine Units Network) Cesarean Registry compared the prevalence of early AROM (4 < cm) in women with a successful vs failed TOLAC. They found that early AROM was associated with a 34% decrease in VBAC success ( p < 0.01) with no higher rates of chorioamnionitis [ 19 ]. However, our study only includes women with early AROM, limiting the relevance of the MFMU study to our findings.…”

Section: Discussionmentioning

confidence: 99%

Artificial rupture of membranes as a mode for induction of labor in women with a previous cesarean section- a retrospective cohort study

Dick

Gutman-Ido

Chill

et al. 2022

BMC Pregnancy Childbirth

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Background Induction of labor in women with a previous cesarean section (CS) is associated with increased rates of uterine rupture and failed attempt for vaginal delivery. Prostaglandins use is contraindicated in this population, limiting available options for cervical ripening. Objective To evaluate the efficacy and safety of artificial rupture of membranes (AROM) as a mode of Induction of labor (IOL) in women with a previous cesarean section. Methods A retrospective cohort study conducted in a single tertiary care center between January 2015 and October 2020. Women with one previous cesarean section and a current singleton term pregnancy requiring IOL, with an unfavorable cervix, were included. The primary outcome was a successful vaginal delivery (VBAC); secondary outcomes were rates of chorioamnionitis, uterine rupture and low Apgar score (< 7). Results Of the 665 women who met the inclusion criteria, 492 (74%) did not receive subsequent oxytocin and 173 (26%) did. There were significant differences in the baseline characteristics between these two groups, including maternal age, cervical dilation at presentation, parity, and a history of a previous VBAC. Among women who were induced solely by AROM the rate of a successful TOLAC was higher (81.3% vs 73.9%), total time of IOL was shorter (mean 8.7 h vs.16.1 h) and the risk of chorioamnionitis was lower (7.3% vs 18.4%). When subdividing the women who received oxytocin into early (< 12 h after AROM) vs late (> 12 h after AROM) administration, there were no significant changes in the rates of successful VBAC or of chorioamnionitis. Conclusion AROM as a single mode of IOL in women with a previous CS is a safe and efficient practice with high rates of successful VBAC. When spontaneous labor does not develop, there is no advantage to delay the administration of oxytocin.

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Section: Discussionmentioning

confidence: 99%

Artificial rupture of membranes as a mode for induction of labor in women with a previous cesarean section- a retrospective cohort study

Dick

Gutman-Ido

Chill

et al. 2022

BMC Pregnancy Childbirth

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“…Pasko et al published a retrospective cohort study of patients with obesity indicating that early amniotomy is associated with a higher risk of cesarean delivery [8]. Similarly, Varvoutis et al published a case-control study using a large network cesarean registry and found that early amniotomy was not associated with higher rates of vaginal birth after cesarean [9]. One subpopulation where benefit of early amniotomy is less clear are patients who have low cervical This article is protected by copyright.…”

Section: Introductionmentioning

confidence: 99%

“…4 However, for some subpopulations the impact of early amniotomy is less clear. [8][9][10] Pasko et al published a retrospective cohort study of patients with obesity indicating that early amniotomy is associated with a higher risk of cesarean delivery. 8 Similarly, Varvoutis et al published a case-control study using a large network cesarean registry and found that early amniotomy was not associated with higher rates of vaginal birth after cesarean.…”

mentioning

confidence: 99%

“…8 Similarly, Varvoutis et al published a case–control study using a large network cesarean registry and found that early amniotomy was not associated with higher rates of vaginal birth after cesarean. 9 One subpopulation where benefit of early amniotomy is less clear are patients who have low cervical effacement or a “thick” cervix. The rising use of cervical ripening balloons for mechanical dilation has resulted in more patients, with dilations greater than 3 to 4 cm after cervical ripening balloon expulsion but with effacements that remain low.…”

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confidence: 99%

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The Impact of Cervical Effacement at Time of Amniotomy in Patients Undergoing Induction of Labor

et al. 2023

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Objective: There is evidence to suggest that early amniotomy during induction of labor is advantageous. However, following cervical ripening balloon removal the cervix remains less effaced and the utility of amniotomy in this setting is less clear. We investigated whether cervical effacement at the time of amniotomy impacts outcomes among nulliparas undergoing induction of labor. Study Design: This was a secondary analysis of a prospective cohort of singleton, term, nulliparous patients at a tertiary care center undergoing induction of labor and amniotomy. The primary outcome was completion of the first stage of labor. Secondary outcomes were vaginal delivery and postpartum hemorrhage. Outcomes were compared between patients with cervical effacement ≤50% (low effacement) and >50% (high effacement) at time of amniotomy. Multivariable logistic regression was used to adjust for confounders including cervical dilation. Stratified analysis was performed in patients with cervical ripening balloon use. A post-hoc sensitivity analysis was performed to further control for cervical dilation. Results: Of 1256 patients, 365 (29%) underwent amniotomy at low effacement. Amniotomy at low effacement was associated with reduced likelihood of completing the first stage (aRR 0.87 [95% CI 0.78-0.95]) and vaginal delivery (aRR 0.87 [95% CI 0.77-0.96]). Although amniotomy at low effacement was associated with lower likelihood of completing the first stage in all-comers, those who had amniotomy performed at low effacement following cervical ripening balloon expulsion were at highest risk (aRR 0.84 [95% CI 0.69-0.98] P for interaction= 0.04) In the post-hoc sensitivity analysis, including patients who underwent amniotomy at 3 or 4 centimeters dilation, low cervical effacement remained associated with a lower likelihood of completing the first stage of labor. Conclusion: Low cervical effacement at time of amniotomy, particularly following cervical ripening balloon expulsion, is associated with a lower likelihood of successful induction.

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Guideline No. 432c: Induction of Labour

Robinson

Campbell

Hobson³

et al. 2023

Journal of Obstetrics and Gynaecology Canada

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Is Early Amniotomy Associated with Higher Likelihood of Vaginal Birth after Cesarean?

Cited by 5 publications

References 14 publications

Artificial rupture of membranes as a mode for induction of labor in women with a previous cesarean section- a retrospective cohort study

Artificial rupture of membranes as a mode for induction of labor in women with a previous cesarean section- a retrospective cohort study

The Impact of Cervical Effacement at Time of Amniotomy in Patients Undergoing Induction of Labor

Guideline No. 432c: Induction of Labour

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