Originally published by 2 Minute Medicine^® (view original article). Reused on AccessMedicine with permission.

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

1. Artificial rupture of membranes (AROM) alone is a safe and efficient way to induce labour in women with previous cesareansection.

Evidence Rating Level: 2 (Good)

Induction of labour (IOL) is an increasing practice and currently can be done by use of oxytocin, prostaglandins, artificial rupture of membranes (AROM) and balloon catheters. Those who have had previous c-section have limited options for IOL as prostaglandins and oxytocin are contraindicated due to increased risk of uterine rupture. Minimal studies have evaluated the use of AROM as a non-pharmacological mode of IOL for those with a history of c-section. This study aimed to examine if AROM was safe and effective in this population. This study also investigated if delayed or early administration of oxytocin is beneficial for those who did not go into active labour after AROM. This retrospective study consisted of 665 women with a history of one prior c-section and were undergoing trial of labor after cesarean (TOLAC). The primary outcome was the rate of successful vaginal delivery. Women had AROM and then were admitted to hospital to await onset of spontaneous labour. 492 of the women did not receive or require oxytocin, 172 did and these were broken into two groups, early (< 12 hour) and late (> 12 hour) oxytocin administration. Those who only received AROM for IOL had a higher rate of successful vaginal delivery (81.3% vs.73.9% p = 0.03), a lower total time of induction of labour (8.7 h vs.16.13 h p < 0.001) and lower risk of chorioamnionitis. Between those who received early versus late oxytocin, no significant differences were seen in rates of successful vaginal delivery or chorioamnionitis. However this study was limited, between the groups who received AROM alone vs AROM + oxytocin, as there were large differences such as higher rates of previous vaginal delivery, prior vaginal birth after c-section, larger cervical dilation and older age. Once these differences were accounted for, there were no differences in rates of successful vaginal delivery after c-section. Despite these limitations, this study demonstrates that AROM is a safe way to begin IOL and can be used alone patients where other treatment options are contraindicated or limited.

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