Management of Labor in Patients With Previous Cesarian Section

Management of Labor in Patients With Previous Cesarian Section and Premature Rupture of Membranes Who Desire TOLAC: Comparison Between the Use of Standard Expectant Management and the Double-balloon Catheter Device. A Prospective Randomized Study

Induction of labor in women desiring TOLAC has long been a topic of controversy. The paucity of published data on mechanical cervical ripening in the setting of TOLAC and term PROM has led us to undertake the present clinical trial.

Inclusion Criteria:

• Diagnosed to be pregnant with PROM at >34 weeks. Rupture of membranes will be determine clinically and confirmed by positive Nitrazine test.
• Ruptured membranes have occurred in the last 24 hours prior to inclusion in the study.
• Found to have an unripe cervix in a speculum examination.
• Singleton pregnancy in a vertex presentation well applied to the cervix and absence of significant and regular uterine contractions (3-5/10 Min)
• Previous on cesarian section.
• Willingness to comply with the protocol for the duration of the study.
• Have signed an informed consent.

Exclusion Criteria: Patients having any of the following conditions:

• Any contraindication for the vaginal delivery (i.e. placenta previa, non vertex presentation).
• Regular uterine contractions (3-5/10 min).
• Diagnosis of rupture membranes was made over 24 hours prior the study inclusion.
• Evidence of chorio-amnionitis (T 37.6 celsious Degree with uterine tenderness and maternal or fetal tachycardia or purulent discharge or WBC>/=20,000)
• Suspected placental abruption or presence of a significant hemorrhage.
• Non-reassuring fetal status (as determined by fetal heart rate monitoring and/or bio-physical profile) necessitating immediate intervention.