Risk of uterine rupture with a trial of labor in women with multiple and single prior cesarean delivery.

Abstract:

OBJECTIVE:To determine whether the risk for uterine rupture is increased in women attempting vaginal birth after multiple cesarean deliveries. METHODS:We conducted a prospective multicenter observational study of women with prior cesarean delivery undergoing trial of labor and elective repeat operation. Maternal and perinatal outcomes were compared among women attempting vaginal birth after multiple cesarean deliveries and those with a single prior cesarean delivery. We also compared outcomes for women with multiple prior cesarean deliveries undergoing trial of labor with those electing repeat cesarean delivery. RESULTS:Uterine rupture occurred in 9 of 975 (0.9%) women with multiple prior cesarean compared with 115 of 16,915 (0.7%) women with a single prior operation (P = .37). Multivariable analysis confirmed that multiple prior cesarean delivery was not associated with an increased risk for uterine rupture. The rates of hysterectomy (0.6% versus 0.2%, P = .023) and transfusion (3.2% versus 1.6%, P < .001) were increased in women with multiple prior cesarean deliveries compared with women with a single prior cesarean delivery attempting trial of labor. Similarly, a composite of maternal morbidity was increased in women with multiple prior cesarean deliveries undergoing trial of labor compared with those having elective repeat cesarean delivery (odds ratio 1.41, 95% confidence interval 1.02-1.93). CONCLUSION:A history of multiple cesarean deliveries is not associated with an increased rate of uterine rupture in women attempting vaginal birth compared with those with a single prior operation. Maternal morbidity is increased with trial of labor after multiple cesarean deliveries, compared with elective repeat cesarean delivery, but the absolute risk for complications is small. Vaginal birth after multiple cesarean deliveries should remain an option for eligible women. LEVEL OF EVIDENCE:II-2.

journal_name

Obstet Gynecol

authors

Landon MB,Spong CY,Thom E,Hauth JC,Bloom SL,Varner MW,Moawad AH,Caritis SN,Harper M,Wapner RJ,Sorokin Y,Miodovnik M,Carpenter M,Peaceman AM,O'sullivan MJ,Sibai BM,Langer O,Thorp JM,Ramin SM,Mercer BM,Gabbe SG,Na

doi

10.1097/01.AOG.0000224694.32531.f3

subject

Has Abstract

pub_date

2006-07-01 00:00:00

pages

12-20

issue

1

eissn

0029-7844

issn

1873-233X

pii

108/1/12

journal_volume

108

pub_type

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