Risk of Uterine Rupture during Labor among Women with a Prior Cesarean Delivery

Lydon‐Rochelle, Mona T.; Holt, Victoria L.; Easterling, Thomas R.; Martin, Diane P.

doi:10.1056/nejm200107053450101

Cited by 851 publications

(434 citation statements)

References 10 publications

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“…In the present study, we have no perinatal deaths because we have no uterine ruptures. This is supported by the finding of Lydon-Rochelle et al [8] who found the rate of infant mortality was 5.5% in cases involving uterine rupture, compared with 0.5% without rupture.…”

Section: Discussionsupporting

confidence: 61%

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Optimization of clinical outcome of women with previous one lower segment cesarean section

Eskandar¹,

Aboud²,

Alshahrani³

et al. 2012

OJOG

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Background and Objectives: To investigate the outcome in women with planned Vaginal Birth After Cesarean (VBAC) in comparison to Repeat Cesarean Section (RCS) and to those undergoing vaginal birth. Design and Settings: Retrospective study, women with a history of one lower segment cesarean section (LSCS) admitted to Abha General Hospital for delivery from September, 2010 to February, 2011. Subjects and Methods: The demographic maternal and neonatal data and data concerning the course of delivery were reviewed in 418 women underwent trial of labor (TOL) and subjected to statistical analysis to study the predictive factors and outcome. All cases were divided into 3 groups, VBAC group (212 women), RCS group (206 women) and the neonates of the VBAC group were compared to those of a control group consists of 287 neonates who were delivered vaginally. Results: The success rate of VBAC was 50.72%, with no uterine rupture or wound dehiscence. Failure to progress was the most common (40.2%) indication of RCS followed by fetal distress (29.9%). Young maternal age (P < 0.05), previous vaginal deliveries after CS (P < 0.05) and occiput anterior position (P < 0.01) were significantly associated with successful VBAC. Neonatal Intensive Care Unit (NICU) admission was significantly higher in the RCS group (P < 0.001), while no significant difference was found between NICU admission in the VBAC and the control groups. Conclusion: VBAC should remain an available option. Informed consent, good reporting and thorough documentation of the VBAC decision are crucial. During TOL, continuous fetal monitoring and, ultrasound evaluation of the previous scar are recommended. Emergency CS should be considered if duration of the TOL is prolonged with non reassuring CTG.

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Section: Discussionsupporting

confidence: 61%

“…It is more likely with shorter interval between pregnancies < 18 months [7], with labor induction or oxytocin augmentation [8], macrocosmic babies [9] and postdates pregnancies [10].…”

Section: Discussionmentioning

confidence: 99%

Optimization of clinical outcome of women with previous one lower segment cesarean section

Eskandar¹,

Aboud²,

Alshahrani³

et al. 2012

OJOG

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“…We found a difference in the duration of labor in the two groups, 6 hrs in the group that was induced as against 9.75 hrs in the group that was not induced, a difference of 3.75 hrs (P ≤ 0.001). In a study carried out over four years but with a smaller sample size where misoprostol was matched against oxytocin in induction of twin gestations greater than 34 weeks, the duration of labor in oxytocin group was 15.1 hrs [37].…”

Section: Discussionmentioning

confidence: 99%

Twin gestation: Is induction of labor possible in highly selected cases?

Mbu¹,

Fouedjio²,

Fouelifack³

et al. 2012

OJOG

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Induction of labor has been in practice for several decades but the decision to induce labor in multifetal gestations has not been accepted by many practitioners in contemporary obstetrics. The aim of this study was to compare maternal and fetal outcomes among women with uncomplicated twin gestations who were induced at term and those who were not. It was a cross-sectional analytic study that lasted ten years, (1 st January 2000 to 31 st December 2009 inclusive) at the maternity of the central hospital, Yaounde, Cameroon. 158 women were enrolled, 79 were induced and 79 went into labor spontaneously. Maternal and fetal outcomes, duration of labor, the prevalence of caesarean section were compared in the two groups. The average age of the women in the groups was 26, 75 ± 3.65 years (range 15 -41 years). For those who were induced, indication was premature rupture of membranes in 44 (56%) of cases. The characteristics of induced and none induced women were similar, except for the number of antenatal consultations (P ≤ 0.001). There was a significant difference in the duration of labor in the two groups (6 hrs versus 9, 75 hrs; P ≤ 0.001). The overall rate of vaginal delivery in the two groups was 87, 97% (n = 139), 88.87% in the group that was induced versus 86.07% in the group that labor was spontaneous (OR 1, 22; 95% IC 0, 51-2, 92; P ≤ 0.90). With respect to primary outcomes, there were no statistically significant differences between the group that labor was induced and that which labor was spontaneous. The prevalence of caesarean delivery was similar in the two groups (10%, 12% vs 13%, 92%; OR 0%, 7%; 95% IC 0, 27-1, 85; P ≤ 0.50). The main indications for caesarean section were acute fetal distress and failed induction. The first and fifth minute APGAR scores less than 7 in the first twins delivered in the two groups were similar. The 312 children delivered in both arms did not show any complications at birth. However, there were 3 neonatal deaths (1 vs 2). There were no cases of uterine rupture or maternal deaths among the 156 women. Induction of labor may be proposed to women with uncomplicated term twin gestations with specific indications. Induction in these highly selected cases does not impute any additional risks but close monitoring of labor is very necessary.

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“…To decrease the rate of CD, the American College of Obstetricians and Gynecologists recommended that most pregnant women with a single previous low transverse CD be counseled and offered a TOLAC [6]. The risk of uterine rupture in laboring women with a previous CD varies between 0.2% and 1.5% after induction of labor compared with 0.5% in women with spontaneous labor after a previous CD [7] [8]. It is important in the counseling of TOLAC to inform the woman of her chance of success and discuss the maternal and neonatal risks and benefits.…”

Section: Introductionmentioning

confidence: 99%

Measurements of the Lower Uterine Segment at Term in Women with Previous Cesarean Delivery

Kinjo¹,

Masamoto²,

Mekaru³

et al. 2016

OJOG

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Purpose: To evaluate the accuracy of sonographic measurements of the lower uterine segment (LUS) thickness at term in predicting uterine scar defects in women with previous Cesarean delivery (CD). Methods: Eighty-nine pregnant women who underwent CD between 37 and 41 weeks of gestation from 2013 to 2015 were enrolled in this study and divided into two groups. Group A consisted of women with previous CD, and Group B consisted of women with previous vaginal deliveries. We performed an ultrasound evaluation of the myometrial and full thickness of LUS (mLUS and fLUS) transvaginally before a CD and evaluated the appearance of LUS during surgery, which was defined as follows: grade I, well-developed; grade II, thin without visible content; grade III, translucent with visible content; and grade IV, either dehiscence or rupture. Results: The median mLUS and fLUS were 1.50 and 4.07 mm in the group A, and 2.75 and 5.37 mm in the group B. We observed significant differences in the median mLUS and fLUS between grades I/II (2.07 and 4.37 mm) and grades III/IV (0.67 and 2.52 mm). Both mLUS and fLUS were predictive factors for grades III/IV and cutoff values were 0.97 mm of mLUS and 3.13 mm of fLUS, having a sensitivity of 87.5% and 75.0%, and a specificity of 87.7% and 91.4% in mLUS and fLUS measurement, respectively. Conclusion: Sonographic measurements of LUS at term may be a feasible and reliable method to predict uterine rupture or uterine dehiscence in women with prior CD.

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Risk of Uterine Rupture during Labor among Women with a Prior Cesarean Delivery

Abstract: For women with one prior cesarean delivery, the risk of uterine rupture is higher among those whose labor is induced than among those with repeated cesarean delivery without labor. Labor induced with a prostaglandin confers the highest risk.

Cited by 851 publications

References 10 publications

Optimization of clinical outcome of women with previous one lower segment cesarean section

Optimization of clinical outcome of women with previous one lower segment cesarean section

Twin gestation: Is induction of labor possible in highly selected cases?

Measurements of the Lower Uterine Segment at Term in Women with Previous Cesarean Delivery

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