Download PDF
Am J Perinatol 2004; 21(4): 217-222
DOI: 10.1055/s-2004-828608
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Uterine Rupture in Patients with a Prior Cesarean Delivery: The Impact of Cervical Ripening

Matthew K. Hoffman1 , Anthony Sciscione1 , Maha Srinivasana1 , D. Paul Shackelford2 , Lamar Ekbladh1
  • 1Department of Obstetrics and Gynecology, Christiana Care Health Services, Newark, Delaware
  • 2Department of Obstetrics and Gynecology, East Carolina University School of Medicine, Wilmington, North Carolina
Further Information

Publication History

Publication Date:
28 May 2004 (online)

    Permissions and Reprints

The purpose of this study was to examine factors that were associated with uterine rupture in patients attempting vaginal birth after cesarean delivery. We analyzed the results of all patients attempting vaginal birth after cesarean delivery between September 1996 to December 1999 at a single institution using a contemporaneously maintained registry. Maternal factors, fetal factors, and management of labor were all assessed to determine the risk factors associated with symptomatic uterine rupture at the time of attempted vaginal birth after cesarean delivery. Twenty-eight symptomatic ruptures were identified in 972 attempts of vaginal birth after cesarean delivery at a gestational age greater than 24 weeks (2.88%). The use of preinduction cervical ripening was significantly associated with an increased risk of symptomatic uterine rupture (odds ratio, 3.92; 95% confidence interval, 1.78 to 8.62). Patients who underwent preinduction cervical ripening were significantly less likely to delivery vaginally than women who had not (46.71 versus 76.87%; p < 0.001). No other differences were noted between the two groups. Preinduction cervical ripening is associated with an increased risk of uterine rupture in women attempting vaginal birth after cesarean delivery.

KEYWORDS

Uterine rupture - vaginal birth after cesarean delivery - cervical ripening - induction

REFERENCES

  • 1 McMahon M J et al.. Comparison of a trial of labor with an elective second cesarean section [see comments].  N Engl J Med. 1996;  335 689-695
    CrossrefPubMedGoogle Scholar
  • 2 Flamm B L et al.. Elective repeat cesarean delivery versus trial of labor: a prospective multicenter study.  Obstet Gynecol. 1994;  83 927-932
    PubMedGoogle Scholar
  • 3 Jones R O et al.. Rupture of low transverse cesarean scars during trial of labor [see comments].  Obstet Gynecol. 1991;  77 815-817
    PubMedGoogle Scholar
  • 4 Scott J R. Mandatory trial of labor after cesarean delivery: an alternative viewpoint [see comments].  Obstet Gynecol. 1991;  77 811-814
    PubMedGoogle Scholar
  • 5 Approach VBAC deliveries cautiously, experts say.  Hosp Peer Rev. 1998;  23 189
    PubMedGoogle Scholar
  • 6 Sciscione A C et al.. Uterine rupture during preinduction cervical ripening with misoprostol in a patient with a previous caesarean delivery.  Aust N Z J Obstet Gynaecol. 1998;  38 96-97
    PubMedGoogle Scholar
  • 7 Wing D A, Lovett K, Paul R H. Disruption of prior uterine incision following misoprostol for labor induction in women with previous cesarean delivery.  Obstet Gynecol. 1998;  91 828-830
    CrossrefPubMedGoogle Scholar
  • 8 Hawe J A, Olah K S. Posterior uterine rupture in a patient with a lower segment caesarean section scar complicating prostaglandin induction of labor [see comments].  Br J Obstet Gynaecol. 1997;  104 857-858
    CrossrefPubMedGoogle Scholar
  • 9 Bennett B B. Uterine rupture during induction of labor at term with intravaginal misoprostol.  Obstet Gynecol. 1997;  89(5 pt 2) 832-833
    CrossrefPubMedGoogle Scholar
  • 10 Zelop C M et al.. Uterine rupture during induced or augmented labor in gravid women with one prior cesarean delivery.  Am J Obstet Gynecol. 1999;  181 882-886
    CrossrefPubMedGoogle Scholar
  • 11 Sciscione A C et al.. A prospective, randomized comparison of Foley catheter insertion versus intracervical prostaglandin E2 gel for preinduction cervical ripening.  Am J Obstet Gynecol. 1999;  180 55-60
    CrossrefPubMedGoogle Scholar
  • 12 Flamm B L. Once a cesarean always a controversy.  Obstet Gynecol. 1997;  90 312-315
    CrossrefPubMedGoogle Scholar
  • 13 Naef III R F et al.. Trial of labor after cesarean delivery with a lower-segment, vertical uterine incision: is it safe?.  Am J Obstet Gynecol. 1995;  172 1666-1674
    CrossrefPubMedGoogle Scholar
  • 14 Swaim L S, Holste C S, Waller D K. Umbilical cord blood pH after prior cesarean delivery.  Obstet Gynecol. 1998;  92 390-393
    CrossrefPubMedGoogle Scholar
  • 15 Plauche W C, Von Almen W, Muller R. Catastrophic uterine rupture.  Obstet Gynecol. 1984;  64 792-797
    PubMedGoogle Scholar
  • 16 Socol M L, Peaceman A M. Vaginal birth after cesarean: an appraisal of fetal risk.  Obstet Gynecol. 1999;  93 674-679
    CrossrefPubMedGoogle Scholar
  • 17 MacKenzie I Z, Bradley S, Embrey M P. Vaginal prostaglandins and labour induction for patients previously delivered by caesarean section.  Br J Obstet Gynaecol. 1984;  91 7-10
    PubMedGoogle Scholar
  • 18 Blanco J D et al.. Prostaglandin E2 gel induction of patients with a prior low transverse cesarean section.  Am J Perinatol. 1992;  9 80-83
    PubMedGoogle Scholar
  • 19 Turner J E et al.. Prostaglandin E2 in tylose gel for cervical ripening before induction of labor.  J Reprod Med. 1987;  32 815-821
    PubMedGoogle Scholar
  • 20 Goldberger S B et al.. The use of PGE2 for induction of labor in parturients with a previous cesarean section scar.  Acta Obstet Gynecol Scand. 1989;  68 523-526
    PubMedGoogle Scholar
  • 21 Flamm B L et al.. Prostaglandin E2 for cervical ripening: a multicenter study of patients with prior cesarean delivery.  Am J Perinatol. 1997;  14 157-160
    PubMedGoogle Scholar
  • 22 Ravasia D J, Wood S L, Pollard J K. Uterine rupture during induced trial of labor among women with previous cesarean delivery.  Am J Obstet Gynecol. 2000;  183 1176-1179
    CrossrefPubMedGoogle Scholar
  • 23 Plaut M M, Schwartz M L, Lubarsky S L. Uterine rupture associated with the use of misoprostol in the gravid patient with a previous cesarean section.  Am J Obstet Gynecol. 1999;  180 1535-1542
    CrossrefPubMedGoogle Scholar
  • 24 Hofmeyr G J, Gulmezoglu A M, Alfirevic Z. Misoprostol for induction of labour: a systematic review.  Br J Obstet Gynaecol. 1999;  106 798-803
    PubMedGoogle Scholar
  • 25 Leung A S et al.. Risk factors associated with uterine rupture during trial of labor after cesarean delivery: a case-control study.  Am J Obstet Gynecol. 1993;  168 1358-1363
    CrossrefPubMedGoogle Scholar
  • 26 Rosen M G, Dickinson J C, Westhoff C L. Vaginal birth after cesarean: a meta-analysis of morbidity and mortality.  Obstet Gynecol. 1991;  77 465-470
    PubMedGoogle Scholar
  • 27 Bujold E, Bujold C, Hamilton E F, Harel F, Gauthier R J. The impact of a single-layer or double-layer closure on uterine rupture.  Am J Obstet Gynecol. 2002;  186 1326-1330
    CrossrefPubMedGoogle Scholar

Matthew K HoffmanM.D. M.P.H. 

Department of Obstetrics and Gynecology, Christiana Care Health Services

4755 Ogletown-Stanton Road

Newark, DE 19718

      >