Uterine rupture during trial of labor after previous cesarean section

Article Abstract:

The cesarean section rate in the US is considered by medical, financial, and patient representatives to be too high, and one current trend is to attempt vaginal delivery after a previous section. However, some clinicians believe that this not advisable, because the scar from the previous surgery may separate causing uterine rupture. A study was undertaken to learn more about the rate of uterine rupture in a large population of women. The rate of uterine scar dehiscence (opening of the scar) without significant blood loss or signs of fetal distress was also examined. The medical records of women with previous cesarean sections were reviewed along with the rate of scar separations during attempted vaginal delivery between January 1983 and December 1989. Of the 119,395 deliveries during the study period, 11,041 women had previous cesarean sections. Labor was attempted by 7,598 of these patients (69 percent), and 6,021 (79.2 percent) delivered vaginally. Uterine rupture occurred in 70 cases (rate of 0.6 percent) and uterine scar dehiscence in 67 cases (0.6 percent). In patients who underwent a trial of labor, the rate of uterine rupture and dehiscence were 0.8 percent and 0.7 percent, respectively. The most common reason for operative intervention when uterine rupture took place was fetal distress. One neonatal death was attributed to this complication. Thirteen patients underwent transfusion and one woman who suffered a rupture died. No maternal deaths occurred among those with uterine scar dehiscence. Fourteen hysterectomies (surgical removal of the uterus) were performed in this group, compared with none in the dehiscence group, and 15 urologic injuries were sustained (compared with two in the dehiscence group). Although the rate of uterine scar separation is small, it is a life-threatening medical emergency. Patients should attempt vaginal birth after previous cesarean only if all facilities for safely managing any complications are available. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Complications and side effects, Childbirth, Delivery (Childbirth), Dehiscence, Surgical wound dehiscence

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Pregnancy outcome in nulliparous women aged 35 or older

Article Abstract:

Pregnant women who are older than 35 years are more likely to have a cesarean section than women in their 20s. A database was used to analyze pregnancy complications in 857 women who were 35 years old or older and delivering their first child. These women were compared with 1,597 women between 20 and 29 years old. The cesarean section rate was 40% for the older women and 18% for the younger women. Fetal distress occurred in 12% of the 35 years-and-older group and in 6.3% of the other group. Twenty-nine percent of the older women did not labor before having a cesarean section as compared to 15% of the younger women. This could reflect the fact that doctors may be more concerned about potential complications in pregnancies in older women.

Pregnancy, Complications of, Pregnancy complications

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Maternal and neonatal outcomes after uterine rupture in labor

Article Abstract:

The risk of uterine rupture during a vaginal birth after a previous cesarean (VBAC) is very low and is unlikely to be fatal to the woman or the baby. In a study of 38,027 deliveries of which 61% were VBAC, only 19 women had a documented uterine rupture.

Complications

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