Is Early Amniotomy Associated with Higher Likelihood of Vaginal Birth after Cesarean?
| Autor: | Varvoutis MS; Division of Maternal Fetal Medicine, Department of OBGYN, Duke University, Durham, North Carolina., Sayres LC; Division of Maternal Fetal Medicine, Department of OBGYN, Duke University, Durham, North Carolina., Dotters-Katz SK; Division of Maternal Fetal Medicine, Department of OBGYN, Duke University, Durham, North Carolina. |
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| Jazyk: | angličtina |
| Zdroj: | AJP reports [AJP Rep] 2020 Jan; Vol. 10 (1), pp. e37-e41. Date of Electronic Publication: 2020 Mar 04. |
| DOI: | 10.1055/s-0040-1702924 |
| Abstrakt: | Objective The study aims to reduce cesarean rates, eligible women are being offered an option of vaginal birth after cesarean (VBAC). However, little data exist regarding efficacy of amniotomy as a tool in this population. We sought to evaluate the impact of early amniotomy on VBAC success. Study Design This is a secondary analysis case-control study using the MFMU (Maternal-Fetal Medicine Units Network) Cesarean Registry. Women were included if they had a singleton pregnancy, were attempting VBAC, and underwent induction with artificial rupture of membranes. Cases were defined as subjects with successful VBAC; controls were defined as subjects with failed trial of labor after cesarean (TOLAC). Early amniotomy was defined as amniotomy at <4 cm. Demographic and obstetric characteristics were compared and multivariate logistic regression was performed. Results A total of 1,490 women were included. Early amniotomy occurred in 59.5% with VBAC versus 63.2% with failed TOLAC ( p = 0.24). After controlling for body mass index, prior vaginal delivery, African-American race, labor length, gestational age, birthweight, epidural use, Foley catheter balloon ripening, induction method and oxytocin use, early amniotomy was associated with a 34% decrease in VBAC success ( p < 0.01). Women who had early amniotomy did not have higher rates of chorioamnionitis (2.8 vs. 2.9%, p > 0.99). Conclusion Unlike data from nulliparous women, our data suggest that induction with early amniotomy does not increase the likelihood of VBAC. Competing Interests: Conflict of Interest The authors report no conflict of interest. |
| Databáze: | MEDLINE |
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