Rate of uterine rupture during a trial of labor in women with one or two prior cesarean deliveries☆,☆☆

Presented at the Nineteenth Annual Meeting of the Society for Maternal-Fetal Medicine, San Francisco, California, January 18-23, 1999.
https://doi.org/10.1016/S0002-9378(99)70317-0Get rights and content

Abstract

Objective: We sought to determine whether there is a difference in the rate of symptomatic uterine rupture after a trial of labor in women who have had 1 versus 2 prior cesarean deliveries. Study Design: The medical records of all women with a history of either 1 or 2 prior cesarean deliveries who elected to undergo a trial of labor during a 12-year period (July 1984–June 1996) at the Brigham and Women’s Hospital were reviewed. Rates of uterine rupture were compared for these 2 groups. Potential confounding variables were controlled by using logistic regression analyses. Results: Women with 1 prior cesarean delivery (n = 3757) had a rate of uterine rupture of 0.8%, whereas women with 2 prior cesarean deliveries (n = 134) had a rate of uterine rupture of 3.7% (P = .001). In a logistic regression analysis that was controlled for maternal age, use of epidural analgesia, oxytocin induction, oxytocin augmentation, the use of prostaglandin E2 gel, birth weight, gestational age, type of prior hysterotomy, year of trial of labor, and prior vaginal delivery, the odds ratio for uterine rupture in those patients with 2 prior cesarean deliveries was 4.8 (95% confidence interval, 1.8-13.2) Conclusions: Women with a history of 2 prior cesarean deliveries have an almost 5-fold greater risk of uterine rupture than those with only 1 prior cesarean delivery. (Am J Obstet Gynecol 1999;181:872-6.)

Section snippets

Material and methods

The discharge diagnoses of all patients admitted to the labor and delivery unit at the Brigham and Women’s Hospital over a 12-year period from July 1984 to June 1996 were searched to identify all women with a prior cesarean delivery. Specifically, medical records of all women with a diagnosis of prior cesarean delivery, trial of labor, repeat cesarean delivery, vaginal birth after cesarean delivery, and uterine rupture were reviewed. From these records, 4393 women who had presented with the

Results

There were 3757 women who had a history of 1 cesarean delivery (1 scar) and 134 women who had 2 prior cesarean deliveries (2 scars). Demographic characteristics, birth weight, and history of prior vaginal delivery in the 2 groups (1 scar and 2 scars) were similar (Table I).

. Patient demographics and obstetric history

Descriptive variable1 scar (n = 3757)2 scars (n = 134)Statistical significance
Maternal age (y)31.2 ± 5.230.8 ± 5.5P = .40
Maternal age >35 y27%27%P = .76
Birth weight (g)3506 ± 4703530

Comment

This study indicates that women with 2 prior cesarean scars are more likely to have a uterine rupture during a subsequent trial of labor than women with only 1 prior cesarean scar (3.7% vs 0.8%, respectively). Even when a variety of variables that are thought either to be protective or to contribute to uterine rupture are controlled for, an almost 5-fold increase in the risk of uterine rupture remained. The uterine rupture rate of 3.7% in the patients with 2 prior cesarean deliveries is

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Reprint requests: Thomas D. Shipp, MD, Department of Obstetrics and Gynecology, Founders 430, Massachusetts General Hospital, Boston, MA 02114.

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