Interdelivery interval and uterine rupture

Bujold, Emmanuel; Mehta, Shobha; Bujold, Camille; Gauthier, Robert

doi:10.1067/mob.2002.127138

Cited by 176 publications

(90 citation statements)

References 13 publications

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“…In addition, several studies have identified short interdelivery intervals of <6, 18 or 24 months as risk factors for UR. [16][17][18] In this study, women with interdelivery intervals of p18 months had a 60% increased risk of a severe outcome related to UR. This information may provide obstetric providers with even more motivation to counsel women who have had a cesarean to postpone a subsequent pregnancy for more than 1 year.…”

Section: Discussionmentioning

confidence: 94%

Severe maternal and perinatal outcomes from uterine rupture among women at term with a trial of labor

et al. 2012

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Objective: To describe maternal and perinatal morbidity and mortality associated with uterine rupture (UR) among women with prior cesarean/s, singleton term pregnancies and a trial of labor after cesarean (TOLAC).Study Design: Linked hospital discharge files and birth/fetal death certificates identified potential cases of UR in Massachusetts from 1990 to 1998 with definitive identification by medical record abstraction.Result: Among the 347 identified URs, severe outcomes occurred in 86 cases (25%), in 49 (14%) of mothers and 49 (14%) of infants. Of the infants, 25 were discharged with a good prognosis. Maternal age and interdelivery interval <18 months (relative risk (RR) ¼ 1.55; 95% confidence interval (CI): 1.05, 2.31) were associated with a severe outcome. The type of hospital and labor were not associated with the increased risk of a severe outcome.Conclusion: Assuming a 0.7% UR rate among women at term with a TOLAC, the increased rate of severe outcomes related to UR above the baseline risk of elective cesarean is estimated to be 1.3 per 1000 TOLACs.

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Section: Discussionmentioning

confidence: 94%

Severe maternal and perinatal outcomes from uterine rupture among women at term with a trial of labor

et al. 2012

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“…The following factors have been examined with regard to their ability to predict uterine rupture during a trial of labour after caesarean delivery: gestational age [4,19], maternal age [15], interdelivery interval [5,16], interpregnancy interval [7], suture technique for closing the hysterotomy [31], birth weight [18,24], previous vaginal delivery [3,6,21], induction of labour [10,28], ethnicity [22], pre-eclampsia or gestational hypertension [20], twin pregnancy [23], labour progress [27], and number of epidural doses [29]. A statistically significant association with uterine rupture was found in more than one study for the following variables: interdelivery or interpregnancy interval (higher risk with short interval, short interdelivery interval being defined as < 24months [16] or < 18 months [5], and short interpregnancy interval as < 6 months [7]), birthweight (higher risk if > 4000g) [18,24], induction of labour (higher risk) [10,32], oxytocin dose (higher risk with higher doses) [8,30], and previous vaginal delivery (lower risk of rupture if the woman ever delivered vaginally) [3,6]. In addition, a systematic review including 12 studies, showed that locked single layer closure of the caesarean hysterorotomy increased the risk of uterine rupture compared with double layer closure [31].…”

Section: B How Common Is Uterine Rupture After Caesarean Delivery?mentioning

confidence: 99%

Prediction of scar integrity and vaginal birth after caesarean delivery

Valentin¹

2013

Best Practice & Research Clinical Obstetrics & Gynaecol

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A statistically significant association with uterine rupture during a trial of labour after caesarean delivery was found in at least two studies for the following variables: interdelivery interval (higher risk with short interval), birthweight (higher risk if > 4000g), induction of labour (higher risk), oxytocin dose (higher risk with higher doses), and previous vaginal delivery (lower risk). However, no clinically useful risk estimation model including clinical variables has been published. A thin lower uterine segment at 35-40 weeks as measured by ultrasound in women with a caesarean hysterotomy scar increases the risk of uterine rupture or dehiscence. However, no cutoff for lower uterine segment thickness can be suggested because of study heterogeneity, and because prospective validation is lacking. Large caesarean hysterotomy scar defects in nonpregnant women seen at ultrasound examination increase the risk of uterine rupture or dehiscence in subsequent pregnancy but the strength of the association is unknown. To sum up, we currently lack a method that can provide a reliable estimate of the risk of uterine rupture or dehiscence during a trial of labour in women with caesarean hysterotomy scar(s).

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“…1 Short interpregnancy intervals that result from unintended rapid repeat pregnancy increase the risk of adverse maternal-child health outcomes. 2,3 Identifying factors that are linked to unintended pregnancy in the postpartum period may help to explain socioeconomic and racial/ethnic disparities in maternal-child outcomes and guide interventions to reduce these disparities. Low educational status (LEdS; <12th grade completion or equivalence) has been recognized as a risk factor for unintended pregnancy.…”

mentioning

confidence: 99%

Unintended rapid repeat pregnancy and low education status: Any role for depression and contraceptive use?

Bennett¹,

Culhane

McCollum

et al. 2006

American Journal of Obstetrics and Gynecology

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Objective-The purpose of this study was to assess the contribution of depressive symptoms and poor contraceptive use early in the first postpartum year to the risk of unintended repeat pregnancy at the end of that year among adults with low educational status (< 12th grade or equivalence).Study design-This was a prospective observational cohort study of 643 sexually active, lowincome, inner-city adult women (age ≥ 19) who enrolled prenatally (14.7 ± 6.9 weeks gestational age) and were followed twice after delivery (3.3 ± 1.3 months and 11.0 ± 1.3 months). Associations were assessed by multivariate logistic regression.Results-Low educational status (odds ratio, 2.32; 95% CI, 1.25-4.33) and less effective contraceptive use (odds ratio, 2.31; 95% CI, 1.05-4.51) were associated with unintended pregnancy. Neither depressive symptoms nor contraceptive use reduced the risk of pregnancy that was associated with low educational status.Conclusion-Low educational status was associated with more than twice the risk of unintended pregnancy 1 year after delivery. We found no evidence that depression or poor contraceptive use mediate this relationship. KeywordsFertility control; Postpartum period; Educational status; Contraception; Depressive symptom; Pregnancy interval A disproportionately large number of unintended pregnancies in the United States occur among women from low-income minority populations. 1 Short interpregnancy intervals that result from unintended rapid repeat pregnancy increase the risk of adverse maternal-child health outcomes. 2,3 Identifying factors that are linked to unintended pregnancy in the postpartum period may help to explain socioeconomic and racial/ethnic disparities in maternal-child outcomes and guide interventions to reduce these disparities. Low educational status (LEdS; <12th grade completion or equivalence) has been recognized as a risk factor for unintended pregnancy. 1,4 However, the mechanisms that link LEdS and pregnancy intention have not been well-defined. Effective contraceptive use is critical for reducing the rates of unintended pregnancy. 5 LEdS has been associated with nonuse of contraception, the use of less effective contraception methods, increased contraceptive failure rates, and reduced adherence to treatment regimens for chronic illnesses. 6,7 Because of its association with both LEdS and the inconsistent use of medications that include contraception, depression might also contribute to the risk of unintended pregnancy. 8,9 Despite these findings, we are not aware of any analyses that directly assess the possible causal links between depression, contraceptive use, and unintended pregnancy in the postpartum period.In this study, we sought to fill a gap in research on disparities in pregnancy intention by directly examining the contribution of postpartum depressive symptoms and contraceptive use regarding the risk of unintended repeat pregnancy among women with LEdS. The specific goals of this study were to assess whether LEdS confers increased risk of unintended repea...

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Interdelivery interval and uterine rupture

Cited by 176 publications

References 13 publications

Severe maternal and perinatal outcomes from uterine rupture among women at term with a trial of labor

Severe maternal and perinatal outcomes from uterine rupture among women at term with a trial of labor

Prediction of scar integrity and vaginal birth after caesarean delivery

Unintended rapid repeat pregnancy and low education status: Any role for depression and contraceptive use?

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