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Complicated primary cesarean delivery increases the risk for uterine rupture at subsequent trial of labor after cesarean

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate whether cesarean delivery (CD) indication, labor status, and other primary CD characteristics affect the risk for uterine rupture in subsequent deliveries.

Methods

A case–control study of women attempting trial of labor after cesarean (TOLAC) in a single, tertiary, university-affiliated medical center (2007–2016). Deliveries complicated by uterine rupture were matched to successful vaginal birth after cesarean (VBAC) deliveries in a 1:3 ratio. Indication, labor status and post-partum complications (postpartum hemorrhage and postpartum infection) at primary CD were compared between study and control group.

Results

During study period, there were 75,682 deliveries, of them, 3937 (5.2%) were TOLAC. Study group included 53 cases of uterine rupture at TOLAC and 159 women with successful VBAC. Women in study group had significantly lower rates of previous VBAC (15.1 vs. 28.9%, p = 0.047). Rate of postpartum complications at primary CD was significantly higher in women with TOLAC complicated by uterine rupture (7.5 vs. 1.9%, respectively, p = 0.042). Utilizing the multivariate logistic regression analysis, postpartum complications remained an independent risk factor for uterine rupture in the following TOLAC (aOR 4.07, 95% CI 1.14–14.58, p = 0.031).

Conclusion

Postpartum hemorrhage and infection, in primary CD, seem to be associated with increased risk for uterine rupture during subsequent TOLAC.

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References

  1. Betrán AP, Ye J, Moller A-B, Zhang J, Gülmezoglu AM, Torloni MR (2016) The increasing trend in caesarean section rates: global, regional and national estimates: 1990–2014. PLoS One 11(2):e0148343

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Buhimschi CS, Zhao G, Sora N, Madri JA, Buhimschi IA (2010) Myometrial wound healing post-cesarean delivery in the MRL/MpJ mouse model of uterine scarring. Am J Pathol 177(1):197–207

    Article  PubMed  PubMed Central  Google Scholar 

  3. Landon MB, Leindecker S, Spong CY et al (2005) The MFMU cesarean registry: factors affecting the success of trial of labor after previous cesarean delivery. Am J Obstet Gynecol 193:1016–1023

    Article  PubMed  Google Scholar 

  4. Tahseen S, Griffiths M (2010) Vaginal birth after two caesarean sections (VBAC-2)—a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections. BJOG Int J Obstet Gynaecol 117(1):5–19

    Article  CAS  Google Scholar 

  5. Shipp TD, Zelop CM, Repke JT, Cohen A, Lieberman E (2001) Interdelivery interval and risk of symptomatic uterine rupture. Obstet Gynecol 97(2):175–177

    PubMed  CAS  Google Scholar 

  6. Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP (2001) Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med 345(1):3–8

    Article  PubMed  CAS  Google Scholar 

  7. Al-Zirqi I, Stray-Pedersen B, Forsén L, Daltveit AK, Vangen S (2016) Uterine rupture: trends over 40 years. BJOG Int J Obstet Gynaecol 123(5):780–787

    Article  CAS  Google Scholar 

  8. Vilchez G, Nazeer S, Kumar K, Warren M, Dai J, Sokol RJ (2017) Contemporary epidemiology and novel predictors of uterine rupture: a nationwide population-based study. Arch Gynecol Obstet 296(5):869–875

    Article  PubMed  Google Scholar 

  9. Landon MB, Hauth JC, Leveno KJ et al (2004) Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med 351(25):2581–2589

    Article  PubMed  CAS  Google Scholar 

  10. Zelop CM, Shipp TD, Repke JT, Cohen A, Caughey AB, Lieberman E (1999) Uterine rupture during induced or augmented labor in gravid women with one prior cesarean delivery. Am J Obstet Gynecol 181:882–886

    Article  PubMed  CAS  Google Scholar 

  11. Bailit JL, Landon MB, Thom E et al (2006) The MFMU cesarean registry: impact of time of day on cesarean complications. Am J Obstet Gynecol 195(4):1132–1137

    Article  PubMed  Google Scholar 

  12. Mizrachi Y, Barber E, Kovo M, Bar J, Lurie S (2018) Prediction of vaginal birth after one ceasarean delivery for non-progressive labor. Arch Gynecol Obstet 297(1):85–91

    Article  PubMed  Google Scholar 

  13. Grobman WA, Lai Y, Landon MB et al (2007) Development of a nomogram for prediction of vaginal birt after cesarean delivery. Obstet Gynecol 109(4):806–812

    Article  PubMed  Google Scholar 

  14. Sciscione AC, Landon MB, Leveno KJ et al (2008) Previous preterm cesarean delivery and risk of subsequent uterine rupture. Obstet Gynecol 111(3):648–653

    Article  PubMed  Google Scholar 

  15. Lannon SMR, Guthrie KA, Vanderhoeven JP, Gammill HS (2015) Uterine rupture risk after periviable cesarean delivery. Obstet Gynecol 125(5):1095–1100

    Article  PubMed  PubMed Central  Google Scholar 

  16. Chen Y, Han P, Wang YJ, Li YX (2017) Risk factors for incomplete healing of the uterine incision after cesarean section. Arch Gynecol Obstet 296(2):355–361

    Article  PubMed  Google Scholar 

  17. Brahmalakshmy BL, Kushtagi P (2015) Variables influencing the integrity of lower uterine segment in post-cesarean pregnancy. Arch Gynecol Obstet 291(4):755–762

    Article  PubMed  CAS  Google Scholar 

  18. El Refaeey AEA, Abdelfattah H, Mosbah A et al (2017) Is early intervention using Mansoura-VV uterine compression sutures an effective procedure in the management of primary atonic postpartum hemorrhage? : a prospective study. BMC Pregnancy Childbirth 17(1):160

    Article  PubMed  PubMed Central  Google Scholar 

  19. Krispin E, Hiersch L, Wilk Goldsher Y, Wiznitzer A, Yogev Y, Ashwal E (2017) Association between prior vaginal birth after cesarean and subsequent labor outcome. J Maternal-Fetal Neonatal Med 27:1–7

    Google Scholar 

  20. Vigorito R, Montemango R, Sconne G, De Stefano R (2016) Obstetric outcome associated with trial of labor in women with three perior cesarean delivery and at least one prior vaginal birth in an area with a particulary high rate of cesarean delivery. J Maternal-Fetal Neonatal Med 29(22):3741–3743

    Article  Google Scholar 

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Funding

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Authors and Affiliations

  1. Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel

    Lina Salman, Anat Shmueli, Eyal Krispin & Arnon Wiznitzer

  2. The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Lina Salman, Liran Hiersch, Anat Shmueli, Eyal Krispin & Arnon Wiznitzer

  3. Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Liran Hiersch

  4. Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, 38100, Hadera, Israel

    Rinat Gabbay-Benziv

  5. The Rappaport Faculty of Medicine, Technion, Haifa, Israel

    Rinat Gabbay-Benziv

Authors
  1. Lina Salman
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  2. Liran Hiersch
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  3. Anat Shmueli
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  4. Eyal Krispin
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  5. Arnon Wiznitzer
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  6. Rinat Gabbay-Benziv
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Contributions

LS: concept and design, data acquisition, data interpretation, manuscript editing. LH: data acquisition and interpretation, manuscript revision. AS: data acquisition and interpretation, manuscript revision. EK: data acquisition and interpretation, manuscript revision. AW: concept of design, data analysis, manuscript revision. RGB: concept and design, data acquisition, data interpretation, manuscript editing.

Corresponding author

Correspondence to Rinat Gabbay-Benziv.

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The authors report no conflicts of interest.

Informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Salman, L., Hiersch, L., Shmueli, A. et al. Complicated primary cesarean delivery increases the risk for uterine rupture at subsequent trial of labor after cesarean. Arch Gynecol Obstet 298, 273–277 (2018). https://doi.org/10.1007/s00404-018-4801-x

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  • DOI: https://doi.org/10.1007/s00404-018-4801-x

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