ABSTRACT
The purpose of this study is to identify pregnancy and labor factors that place women
at increased risk for symptomatic uterine rupture during trial of labor following
cesarean section. The study population consisted of 16 women with uterine rupture
after a trial of labor who were compared with 32 women without uterine rupture after
a trial of labor. Using a case-control study design with a 1:2 match, we examined
risk factors that might be associated with an increased risk of uterine rupture. Cases
were more likely to have an induction of labor with the use of oxytocin and/or amniotomy
(56 vs. 34%) and more likely to undergo augmentation with oxytocin (25 vs. 19%) in
comparison with controls. In addition, cases were more likely to be given oxytocin
(for either induction or augmentation) (75 vs. 50%) and cervical ripening agents (31
vs. 9%) versus controls. Neonates born after uterine rupture had a higher rate of
significant acidosis (pH < 7.0, 57 vs. 0%, p = 0.0002) and lower Apgar scores. There was a significantly higher risk of maternal
infection (36 vs. 3%, p = 0.003), transfusion (13 vs. 0%, p = 0.03), and longer length of stay in patients with uterine rupture. There is a trend
for increased use of augmentation and induction agents to be associated with uterine
rupture. Serious maternal and fetal morbidities are increased following uterine rupture.
KEYWORD
Uterine rupture - uterine contractile agents - trial of labor
