Vaginal birth after cesarean in women with pre-labor rupture of membranes at term

Twenty-four versus 48 hours of expectant management in the setting of premature rupture of membranes at term among women with a prior cesarean delivery

OBJECTIVES

Compare two approaches of expectant management in the setting of term premature rupture of membranes (PROM) among women with prior cesarean delivery.

METHODS

A retrospective study conducted in a tertiary care center during 2006 to 2017, including primiparous women with singleton pregnancy and a prior low-transverse cesarean delivery who presented with term PROM and requested trial of labor after cesarean (TOLAC). Outcomes were compared between the two campuses at our center: campus A enabled expectant management up to 48 hours following PROM and campus B enabled up to 24 hours after PROM.

RESULTS

A total of 158 women met the inclusion criteria and were divided into two groups. Maternal characteristics of the two groups were similar. In campus B, the rate of oxytocin administration was significantly higher as compared with campus A (46.6% versus 26.0%, P = 0.01). The rate of successful TOLAC was similar between the groups (84.0% versus 84.5%, P = 0.96). Rates of chorioamnionitis, uterine rupture, postpartum hemorrhage, recurrent hospitalization, and Apg scores did not differ between the groups.

CONCLUSION

Expectant management up to 48 hours in women with TOLAC presenting with term PROM was associated with a lower rate of induction of labor and similar maternal and neonatal outcomes.

Prediction of successful preterm vaginal birth after cesarean among women who never delivered vaginally

PURPOSE

We aimed to determine the factors associated with a successful trial of labor after cesarean (TOLAC) in the setting of preterm delivery of women with no prior vaginal delivery.

METHODS

A retrospective cohort study conducted at two tertiary medical centers during 2010-2020, including all TOLACs with a single cesarean delivery and no prior vaginal delivery, delivering a singleton preterm newborn. Factors associated with successful vaginal delivery were examined by multivariable analysis.

RESULTS

Of the 232 women with TOLAC who constituted the study cohort, 178 (76.7%) successfully delivered vaginally. Previous cesarean delivery characteristics did not differ between study groups. Maternal characteristics did not differ between TOLAC success and failure groups. The median gestational age at delivery was 35 3/7 weeks (IQR 34 0/7-36 0/7). The rate of epidural analgesia administration was higher in the TOLAC success group (54.5% vs. 35%, p = 0.013). Preterm premature rupture of membranes (PPROM) rate was lower in the TOLAC success group (53.9% vs. 83%, p < 0.001). The rate of induction of labor did not differ between TOLAC success and TOLAC failure groups. There were no cases of uterine rupture. In a multivariable logistic regression analysis, PPROM was the only independent factor associated with TOLAC success [adjusted OR (95% CI) 0.29 (0.10-0.83), p = 0.030].

CONCLUSION

TOLAC in preterm deliveries among women with no prior vaginal delivery is safe, has a high success rate and PPROM is the only negatively associated predictor.