Risk factors for uterine rupture during a vaginal birth after one previous caesarean section: a case-control study.

Abstract

OBJECTIVE:

To study risk factors for uterine rupture (UR) in women with one previous caesarean section (CS) undergoing a vaginal birth after CS (VBAC).

STUDY DESIGN:

A nested case-control study was conducted. Baseline characteristics, general obstetric history, details of the previous CS, current delivery and maternal and neonatal outcome were analysed for 41 cases with a UR and 157 controls (no rupture). Data were extracted from 21 Dutch hospitals.

RESULTS:

Labour induction was more common in cases than in controls (51% vs. 25% respectively, P=0.001), and in case of induction therapy especially the use of prostaglandins (PGE2) was more frequent in the case group (86% vs. 46%, P=0.014 for cases and controls respectively). Patients with UR had a significantly lower Bishop score (median: 2.0 vs. 4.0, P=0.005) and received more augmentation of labour compared to controls (36% vs. 18%, P=0.010). In the multivariate analysis induction with PGE2 and oxytocin, induction with PGE2 alone, and augmentation of labour were independent variables affecting the occurrence of UR (respectively OR 13.0, CI 2.3-74.2; OR 4.6, CI 1.9-11.3 and OR 2.7, CI 1.2-6.3). Forty-four percent of the ruptures can be explained by induction of labour with prostaglandins+/-oxytocin.

CONCLUSION:

Having studied baseline characteristics, general obstetric history, details of the previous CS and of the current delivery, we show that no factors other than the use of PGE2 (+/-oxytocin) in response to a low Bishop score, and augmentation of labour with oxytocin are associated with an increased risk for UR in women undergoing VBAC after one previous CS.

• Authors: C H E Weimar, A C Lim, M L Bots, H W Bruinse, A Kwee
• Journal: European journal of obstetrics, gynecology, and reproductive biology (Eur J Obstet Gynecol Reprod Biol) Vol. 151 Issue 1 Pg. 41-5 (Jul 2010) ISSN: 1872-7654 [Electronic] Ireland
• PMID: 20427113 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Oxytocin
• Dinoprostone

Topics

• Adult
• Case-Control Studies
• Dinoprostone (administration & dosage, adverse effects)
• Female
• Humans
• Labor, Induced (adverse effects)
• Oxytocin (administration & dosage)
• Pregnancy
• Prospective Studies
• Risk Factors
• Uterine Rupture (etiology)
• Vaginal Birth after Cesarean (adverse effects)