VBAC attempt, PROM with no ctx = c/s?

Archived User

VBAC attempt, PROM with no ctx = c/s?

Hi Henci,

I'm just after a little information about a situation a friend finds herself in...

Trying for a VBAC, 2+ yrs after a c/s for breech presentation (footlong).   No breech present this time. 

Waters broke, but no contractions yet.  Just wondering if there is some sort of 'best practice' policy out there for how long is generally allowed between waters breaking (no meconium/baby stable etc) and repeat c/s?  At 40+2days.  No underlying conditions, mother and baby are both healthy.

Dealing with a scary 'shroud waving' Ob here... :(




Henci Goer

RE: VBAC attempt, PROM with no ctx = c/s?
(in response to Archived User)

Hopefully, your friend has begun labor spontaneously by now. According to the introductory section of the Cochrane systematic review of PROM at term, 79% of women will begin labor by 12 hrs and 95% by 24 hrs. The same systematic review makes clear that awaiting spontaneous labor does not increase newborn infection rates despite few babies in the biggest trial being tested or treated for GBS. Endometritis rates are modestly higher with awaiting labor (6 more per 100), but infection rates correlate with number of vaginal exams, so one wonders whether this excess is iatrogenic. The review concludes: "Since planned and expectant management may not be very different, women need to have appropriate information to make informed choices," which means "shroud waving" is not in order. Should your friend exceed 24 hrs or wish to agree to induction, giving Mother Nature a gentle nudge with a physiologic oxytocin regimen should have minimal, if any, effect on her risk of scar rupture. Among 9 studies (I can provide a list if you need it), 2-19 more more women per 1000 induced without involving prostaglandin E2 experienced scar rupture compared with women with spontaneous onset. Doubtless, the oxytocin regimen was an important factor. 

~ Henci 

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