Frequency of uterine rupture after one successful vaginal birth after cesarean section (VBAC) (original) (raw)
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Archives of Gynecology and Obstetrics, 2022
Purpose: Previous cesarean delivery (CD) is the main risk factor for uterine rupture when attempting a trial of labor. Previous vaginal delivery (PVD) is a predictor for trial of labor after cesarean (TOLAC) success and a protective factor against uterine rupture. We aimed to assess the magnitude of PVD as a protective factor from uterine rupture. Methods : A retrospective cohort study was conducted, including women who underwent TOLACs from 2003-2015. Women with and without PVD were compared. Inclusion criteria were one previous CD, trial of labor at ≥24 weeks' gestation, and cephalic presentation. We excluded pre-labor intrauterine fetal death and fetal anomalies. The primary outcome was uterine rupture. Secondary outcomes were maternal and fetal complications. Logistic regression modeling was applied to analyze the association between PVD and uterine rupture while controlling for confounders. Results: A total of 11,235 women undergoing TOLAC were included, 6,795 of whom had a PVD. Women with PVD had signi cantly lower rates of uterine rupture (0.18% vs. 1.1%; OR 0.19, p<0.001), were less likely to be delivered by an emergency CD (13.2% vs. 39.4%, OR 0.17, p<0.0001), were more likely to undergo labor induction (OR 1.56, p<0.0001), and were less likely to undergo an instrumental delivery (OR 0.14, p<0.001). Logistic regression modeling revealed that PVD was the only independent protective factor, with an aOR of 0.22. Conclusion: PVD is the most important protective factor from uterine rupture in patients undergoing TOLAC. A trial of labor following one CD should therefore be encouraged in these patients. Introduction: Cesarean delivery (CD) rates have increased signi cantly worldwide over the past decades. Latest available data show that 21% of women worldwide gave birth by CD (in 2018) ranging from 5% in sub-Saharan Africa to 43% in Latin America and the Caribbean. It is estimated that at this growth rate, by 2030, 28.5% of women worldwide will give birth by CD. Beyond medical indications, many of the CDs are performed as a result of women's and families' preferences as well as due to health professionals' views and beliefs [1]. Rates of trial of labor after cesarean (TOLAC) have uctuated over time. The main reason for the observed reduction in attempted TOLACs is the concern from uterine rupture, occurring in 0.5% of cases [2-5]. Nevertheless, the potential short-and long-term bene ts of a successful vaginal birth after cesarean (VBAC) and the relatively low incidence of uterine rupture, warrant identi cation of subgroups of women with low risk for such an event, who may substantially bene t from TOLAC. Previous studies concluded that TOLAC is a reasonable option for women with a single past CD [6-9]. It was also demonstrated that vaginal birth history, either before or after the CD, was associated with both higher rates of TOLAC success and lower rates of uterine rupture [10-14]. However, most of these studies
American Journal of Obstetrics and Gynecology, 2003
OBJECTIVE: The purpose of this study was to determine the rate of uterine rupture and its complications as the result of trial of labor after previous cesarean delivery. STUDY DESIGN: PubMed was searched from 1989 to 2001, with the terms ''VBAC, uterine rupture,'' ''trial of labor, uterine rupture,'' ''cesarean delivery, uterine rupture,'' and ''scarred uterus, rupture.'' For inclusion, reports had to contain data from at least 100 patients with trials of labor that included a description of adverse outcomes. Duplicate reporting from a single institution was excluded. Odds ratios and 95% CIs were calculated. RESULTS: Seventy-two of the 361 articles (20%) that were identified met the inclusion criteria. A 6.2 per 1000 trial of labor rate of uterine rupture (total = 880 uterine ruptures in 142,075 trials of labor) was determined. For every 1000 trials of labor the uterine rupture-related complication rate was 1.8 for packed red blood cell transfusion, 1.5 for pathologic fetal acidosis (cord pH < 7.00), 0.9 for hysterectomy, 0.8 for genitourinary injury, 0.4 for perinatal death, and 0.02 for maternal death. The perinatal mortality rate was significantly lower among studies from the United States versus other countries (0.3 vs 0.6; odds ratio, 0.50; 95% CI, 0.26-0.94) and in series that exceeded 1000 patients (0.2 vs 1.7; odds ratio, 7.34; 95% CI, 3.94-13.69). CONCLUSION: Although relatively uncommon, uterine rupture is associated with several adverse outcomes, depending on the time of the publication and the site and size of the population that was studied. (Am J Obstet Gynecol 2003;189:408-17.)
Archives of Gynecology and Obstetrics, 2011
Purpose To determine the risk of uterine rupture for women undergoing trial of labour (TOL) with both a prior caesarean section (CS) and a vaginal delivery. Methods A systematic literature search was performed using keywords for CS and uterine rupture. The results were critically appraised and the data from relevant and valid articles were extracted. Odds ratios were calculated and a pooled estimate was determined using the Mantel-Haenszel method. Results Five studies were used for final analysis. Three studies showed a significant risk reduction for women with both a previous CS and a prior vaginal delivery (PVD) compared to women with a previous CS only, and two studies showed a trend towards risk reduction. The absolute risk of uterine rupture with a prior vaginal delivery varied from 0.17 to 0.46%. The overall odds ratio for PVD was 0.39 (95% CI 0.29-0.52, P \ 0.00001). Conclusion Women with a history of both a CS and vaginal delivery are at decreased risk of uterine rupture when undergoing TOL compared with women who have only had a CS.
American Journal of Obstetrics and Gynecology, 2000
There has been little investigation of the impact of previous vaginal delivery on morbidity during a trial of labor after cesarean delivery. McMahon et al 1 examined morbidity during labor and delivery in women undergoing a trial of labor versus elective repeat cesarean delivery. These authors examined morbidity with a trial of labor for the subgroup of women who had both previous cesarean and previous vaginal deliveries. Although they found no clear increase in major morbidity with increasing parity, they did not directly compare the morbidity in women with a prior vaginal birth and morbidity in women without a previous vaginal delivery. In addition, because most of the major morbidity was a result of operative injury (73%) and not uterine rupture, it is not possible to discern the association of previous vaginal delivery with uterine rupture from this study.
Risk of uterine rupture and adverse perinatal outcome at term after cesarean delivery
Obstetrics and Gynecology, 2007
OBJECTIVE: Current information on the risk of uterine rupture after cesarean delivery has generally compared the risk after trial of labor to that occurring with an elective cesarean delivery without labor. Because antepartum counseling cannot account for whether a woman will develop an indication requiring a repeat cesarean delivery or whether labor will occur before scheduled cesarean delivery, the purpose of this analysis was to provide clinically useful information regarding the risks of uterine rupture and adverse perinatal outcome for women at term with a history of prior cesarean delivery.
Association between Births by Caesarean Section and Uterine Rupture
2016
Continued increase in births by caesarean section has influenced the increased occurrence of uterine rupture in many countries of the world. The aim of this study is to determine the association between of the births by caesarean section and uterine rupture. It was a crosssectional study. The research data was collected and recorded in writing (as per birth protocol) in clinic of Obstetrics and Gynaecology, University Clinical Centre of Kosovo. Data for uterine rupture was collected over the study period of five years (from 2010 to 2014), only in women who gave birth by caesarean section. The cases with uterine rupture were recorded over these years, followed by statistical calculations. Of total 15526 women who underwent caesarean section over the study period of five years (from 2010 to 2014), there were 22 cases of uterine rupture thus, with an incidence of 14 per 10,000 deliveries with Caesarean Section and significance level for observed proportion was P<0.0001 (95% confiden...
PloS one, 2017
To estimate the relation of single-layer closure at previous caesarean delivery, and other pre-labour and intra-partum risk factors for complete uterine rupture in trial of vaginal birth after a caesarean (TOLAC) at term. Population-based case-control study. We identified all women (n = 39 742) recorded in the Danish Medical Birth Registry (DMBR) during a 12-year period (1997-2008) with a singleton pregnancy at term and TOLAC. Among these, all women with a complete uterine rupture were identified (cases). Information from the registry was validated against medical records. Controls were selected in the DMBR as the following two births with TOLAC at term and no uterine rupture. Detailed information from cases and controls was collected from manual review of medical records. Main outcome measure was complete uterine rupture during TOLAC at term. Upon validation, 175 cases and 272 controls met the above criteria. After adjustment for possible confounding factors there was no associatio...
BMJ, 2004
To determine the factors associated with an increased risk of perinatal death related to uterine rupture during attempted vaginal birth after caesarean section. Design Population based retrospective cohort study. Setting Data from the linked Scottish Morbidity Record and Stillbirth and Infant Death Survey of births in Scotland, 1985-98. Participants All women with one previous caesarean delivery who gave birth to a singleton infant at term by a means other than planned repeat caesarean section (n = 35 854). Main outcome measures All intrapartum uterine rupture and uterine rupture resulting in perinatal death (that is, death of the fetus or neonate). Results The overall proportion of vaginal births was 74.2% and of uterine rupture was 0.35%. The risk of intrapartum uterine rupture was higher among women who had not previously given birth vaginally (adjusted odds ratio 2.5, 95% confidence interval 1.6 to 3.9, P < 0.001) and those whose labour was induced with prostaglandin (2.9, 2.0 to 4.3, P < 0.001). Both factors were also associated with an increased risk of perinatal death due to uterine rupture. Delivery in a hospital with < 3000 births a year did not increase the overall risk of uterine rupture (1.1, 0.8 to 1.5, P = 0.67). However, the risk of perinatal death due to uterine rupture was significantly higher in hospitals with < 3000 births a year (one per 1300 births) than in hospitals with ≥ 3000 births a year (one per 4700; 3.4, 1.0 to 14.3, P = 0.04). Conclusion Women who have not previously given birth vaginally and those whose labour is induced with prostaglandin are at increased risk of uterine rupture when attempting vaginal birth after caesarean section. The risk of consequent death of the infant is higher in units with lower annual numbers of births.
Scientific reports, 2017
Caesarean section (CS) is increasing globally, and women with prior CS are at higher risk of uterine rupture in subsequent pregnancies. However, little is known about the incidence, risk factors, and outcomes of uterine rupture in women with prior CS, especially in developing countries. To investigate this, we conducted a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health, which included data on delivery from 359 facilities in 29 countries. The incidence of uterine rupture among women with at least one prior CS was 0.5% (170/37,366), ranging from 0.2% in high-Human Development Index (HDI) countries to 1.0% in low-HDI countries. Factors significantly associated with uterine rupture included giving birth in medium- or low-HDI countries (adjusted odds ratio [AOR] 2.0 and 3.88, respectively), lower maternal educational level (≤6 years) (AOR 1.71), spontaneous onset of labour (AOR 1.62), and gestational age at birth <37 weeks (AOR 3....