Early versus late amniotomy among women with one previous caesarean section undergoing induction of labour and achieving successful vaginal birth after caesarean – A retrospective study
Tamma Anusha Reddy, Nitin Alexander Abraham, Angeline Jacintha, Reeta Vijaya Selvi, Swati Rathore, Elza Rebecca Kharsyntiew, Nidhi Elizabeth Cherian, Renisha Vasanthana
A
BSTRACT
Background:
With the increasing rate of caesarean sections (CSs) worldwide, a growing number of women with one previous CS are undergoing induction of labour in an attempt to achieve vaginal birth after caesarean (VBAC). Amniotomy is commonly used during induction, but optimal timing of amniotomy in women attempting trial of labour after caesarean (TOLAC) remains uncertain.
Methods:
A retrospective study of women with singleton vertex pregnancies at ≥ 37 weeks’, with one previous CS for a non-recurrent indication. Labour induction was performed with a Foley catheter followed by oxytocin augmentation. Women were grouped into early amniotomy (performed at oxytocin initiation) and late amniotomy (performed 4 hours later). The primary outcome was induction-to-delivery interval. Blood loss, oxytocin requirement, postpartum complications, and neonatal Apgar scores were secondary outcomes.
Results:
A total of 203 women with successful VBAC were included, with 101 in the early amniotomy group and 102 in the late amniotomy group. Baseline maternal and obstetric characteristics were comparable between groups. Mean labour duration was significantly shorter in the early amniotomy group compared with the late amniotomy group (4.98 ± 3.20 vs 6.06 ± 3.27 hours;
Conclusion:
Among women with one previous CS who achieved successful VBAC following induction of labour, early amniotomy was associated with shorter duration of labour without significant differences in most short-term maternal and neonatal outcomes. These findings suggest a possible labour-shortening benefit of early amniotomy in carefully selected and closely monitored women undergoing TOLAC.