Management of antepartum spontaneous membrane rupture after one previous caesarean section

The management of patients with one previous caesarean section whose membranes rupture spontaneously (SROM) before labour poses a clinical problem. This paper reports the outcome in a consecutive series of 56 such patients who presented after 37 weeks' gestation over 5 years (1983-1987). Vaginal examination was avoided before labour to minimise the risk of infection. Oxytocin was not used for induction, and the spontaneous onset of labour was awaited. The mean SROM-to-delivery interval was 42.6 hours. Only five (9%) patients required a repeat caesarean section. There was no case of scar dehiscence, and only five patients required oxytocin augmentation in labour. There was one case of postpartum endometritis, and none of the neonates showed clinical evidence of infection. In patients with one previous caesarean section whose membranes rupture spontaneously before labour, we suggest that awaiting the spontaneous onset of labour can safely achieve a high rate of vaginal delivery and avoid the need to induce labour with oxytocin.