True rupture of the Caesarean section scar (a 15 year review, 1972–1987)

Meehan, F. P.; Magani, Isaac M.

doi:10.1016/0028-2243(89)90059-2

Cited by 19 publications

(5 citation statements)

References 13 publications

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“…Repeat Caesarean section is mandatory after a CCS due to an incidence of uterine rupture in future pregnancies of 2-8% (compared to 0.5% for LUSCS) (1,5,6). Not all cases of uterine rupture after CCS will be prevented by repeat elective Caesarean section since rupture of the classical scar can occur prior to elective Caesarean section, either antenatally (as with 1 of the women in this study) or in early labour before Caesarean section can be effected (7)(8)(9).…”

Section: Discussionmentioning

confidence: 84%

The Relationship Between Gestational Age and the Incidence of Classical Caesarean Section

Bethune

Permezel

1997

Aust NZ J Obst Gynaeco

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Improved neonatal survival has led to a rise in the number of Caesarean sections being performed in the presence of extreme prematurity. Many of these operations require an incision in the upper uterine segment with consequent ramifications for the management of any subsequent pregnancy. In this analysis of obstetric patients in a tertiary referral institution over a 9-year period, there was an overall Caesarean section rate of 18%. A classical incision was performed in 1% of all caesarean sections, but at 24 weeks' gestation, 20% of Caesarean sections were 'classical'. This frequency decreased to less than 5% at 30 weeks and less than 1% from 34 weeks' gestation. Most women having a classical Caesarean section at term had either a transverse lie or a major degree of placenta praevia.

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Section: Discussionmentioning

confidence: 84%

The Relationship Between Gestational Age and the Incidence of Classical Caesarean Section

Bethune

Permezel

1997

Aust NZ J Obst Gynaeco

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“…Rupture is seen both in unscarred and previously scarred uteri, the most dangerous being a longitudinal rupture in a previously unscarred uterus (Golan 1980). At trial of labour after previous low transverse caesarean section, rupture occurred in 0.45% (Molloy 1987), 0.44% (Meehan 1989) and 0.37% (Stovall 1987) of cases. Trial of labour after caesarean section, even with epidural block and oxytocin augmentation, is now considered acceptable practice, and results in vaginal delivery in 76.5% (Stovall 1987) to 90.8% (Molloy 1987) of cases.…”

Section: Discussionmentioning

confidence: 96%

Rupture of the uterus in labour

Schiøtz¹

1991

Arch Gynecol Obstet

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In this case report a 27-year-old parturient with a previous caesarean section was diagnosed as having had a uterine rupture in labour. The diagnosis was based on the sonographic demonstration of considerable amounts of free fluid in the abdomen 2 h postpartum, and confirmed by finding fetal skin cells in this fluid. There was no hemorrhage and the fluid disappeared overnight. She was managed expectantly and made a rapid and full recovery.

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“…Posterior and lateral uterine wall rupture following vaginal prostaglandin induction has been described in seven cases in the literature 2 , but never in the presence of a lower uterine segment scar anteriorly. Induction of labour, where necessary, is considered safe in women with a lower segment uterine scar 3–5 . In one of the larger series, of induction of labour in 143 women with vaginal prostaglandin E 2 , 76% achieved vaginal delivery (68% in the unfavourable cervix group), with no recorded incidence of scar rupture 3 .…”

Section: Discussionmentioning

confidence: 99%

Posterior uterine rupture in a patient with a lower segment caesarean section scar complicating prostaglandin induction of labour

Hawe

Olàh

1997

BJOG

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A 36 year old woman booked for her eighth pregnancy at 17 weeks of gestation. She had previously had four first trimester miscarriages (three requiring evacuation of the uterus), two normal vaginal deliveries at term, and in her last pregnancy, an emergency lower segment caesarean section at 37 weeks of gestation for antepartum haemorrhage secondary to a major degree of placenta praevia. At her booking visit the mode of delivery was discussed, and a decision was made to allow a trial of vaginal delivery.There were no antenatal complications until 41 weeks of gestation. At that time, the blood pressure was found to be 160/100 mmHg (booking blood pressure 130/70 mmHg) without proteinuria or generalised oedema. Abdominal palpation revealed an appropriately sized fetus, with the head two-fifths palpable. A vaginal examination was performed and the Bishop score was 3. Arrangements were made for prostaglandin induction of labour the next day.At 09:OO she was admitted to the antenatal ward and 1 mg of prostaglandin gel (UpJohn Ltd, Crawley, UK) was inserted into the posterior fornix. Subsequent cardiotocography was normal. After 6 hours the patient was reviewed. She complained of mild, irregular contractions, and vaginal examination revealed the cervix to be 1 cm dilated (Bishop score 5). A further 1 mg of prostaglandin was given. Two hours later contractions had become strong and regular with a frequency of four to five in 10 minutes. A vaginal examination showed the cervix to be 4 cm dilated, cephalic presentation 2 cm above the ischial spines with bulging membranes. Arrangements were made for immediate transfer to the delivery suite during which she complained of increasing and persistent abdominal pain. On arrival at the delivery suite she was noted to be pale, tachycardic and hypotensive. Abdominal palpation revealed increasing abdominal distension and neither fetal parts nor the fundal height could be identified. On vaginal examination the presenting part was no longer palpable, and the fetal heart was absent. An immediate laparotomy through a midline incision was performed, and a 3 L haemoperitoneum was found. The uterus had ruptured posteriorly, the male fetus was lying free in the peritoneal cavity and was stillborn. The lower segment caesarean section scar remained intact. The damage was considered to be too extensive for repair and a total abdominal hysterectomy was performed. Clotting studies remained normal throughout, and she required a total of 6 units of blood. She made an uncomplicated post-operative recovery, and was discharged on the sixth post-operative day. DiscussionUterine rupture is fortunately a rare event. It is seen most commonly where there has been a previous lower segment scar, and it is a rare event in developed countries to see rupture of an unscarred uterus. We know of only two cases of uterine rupture following vaginal prostaglandin E, (PGE,) induction of labour (without oxytocin) in women with a previous caesarean section scar described in the literature'. In both the rupture involved...

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True rupture of the Caesarean section scar (a 15 year review, 1972–1987)

Cited by 19 publications

References 13 publications

The Relationship Between Gestational Age and the Incidence of Classical Caesarean Section

The Relationship Between Gestational Age and the Incidence of Classical Caesarean Section

Rupture of the uterus in labour

Posterior uterine rupture in a patient with a lower segment caesarean section scar complicating prostaglandin induction of labour

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