Am J Perinatol 2016; 33(06): 577-583
DOI: 10.1055/s-0035-1570382
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Labor Dystocia and the Risk of Uterine Rupture in Women with Prior Cesarean

Chantale Vachon-Marceau
1   Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec, Canada
,
Suzanne Demers
1   Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec, Canada
2   Centre de Recherche, Centre Hospitalier Universitaire de Québec, Québec, Canada
,
Martine Goyet
3   Department of Obstetrics and Gynecology, Hôpital de LaSalle, Montréal, Québec, Canada
,
Robert Gauthier
4   Department of Obstetrics and Gynecology, Faculty of Medicine, Hôpital Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
,
Stéphanie Roberge
2   Centre de Recherche, Centre Hospitalier Universitaire de Québec, Québec, Canada
,
Nils Chaillet
5   Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
,
Jasmin Laroche
2   Centre de Recherche, Centre Hospitalier Universitaire de Québec, Québec, Canada
,
Emmanuel Bujold
1   Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec, Canada
2   Centre de Recherche, Centre Hospitalier Universitaire de Québec, Québec, Canada
› Author Affiliations
Further Information

Publication History

11 August 2015

11 November 2015

Publication Date:
05 January 2016 (online)

Abstract

Objective The objective of this study was to evaluate the association between labor dystocia and uterine rupture.

Methods We performed a secondary analysis of a multicenter case–control study that included women with single, prior, low-transverse cesarean section who experienced complete uterine rupture during a trial of labor (TOL). For each case, three women who underwent a TOL without uterine rupture were selected as controls. Data were collected on cervical dilatations from admission to delivery. We evaluated the relationship between uterine rupture and labor dystocia according to several criteria, including the World Health Organization's (WHO's) partogram.

Results Data were available for 90 cases and 260 controls. Compared with the controls, uterine rupture was associated with less cervical dilatation on admission, slower cervical dilatation in the first stage of labor and longer second stage of labor (all with p < 0.05). Performing cesarean when the labor curve crossed the ACTION line of WHO's partogram or when the second stage was greater than 2 hours could have (1) prevented up to 56% of uterine rupture and (2) reduced the duration of labor in 57% of women with failed TOL.

Conclusion Labor dystocia is a significant risk factor for uterine rupture. Labor progression should be assessed regularly in women with prior cesarean.

 
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