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Dear Prof. Ortmann,
We want to congratulate Tsz‐Kin Lo for raising this important point.
Indeed, we found vacuum-assisted vaginal birth after Cesarean (VA‐VBAC) was an independent factor for adverse maternal outcome including uterine rupture in 0.4% 3/679 cases [1] as compared with primigravid women.
As in the cases reported by Lo., all cases in our study were diagnosed in the postpartum period.
Uterine rupture is a rare complication on that may be associated with significant maternal and fetal mortality. A previous uterine scar, especially from a previous cesarean section, is the most common predisposing factor and is estimated at 0.5% in these women [2].
In our recent study [3], we reported 29 cases (of overall 143, 20.3%) of intrapartum uterine rupture which were diagnosed following a vaginal delivery, during the early postpartum period while in 15/29 (51.7%) women, the rupture was diagnosed following vacuum-assisted vaginal birth, mostly due to non‐reassuring fetal heart rate (14/15, 93%). Therefore, we agree with this author's comment that uterine rupture should be suspected following the delivery of women with a history of cesarean especially in cases where a vacuum extraction was performed due to non‐reassuring fetal status.
References
Rottenstreich M, Rotem R, Katz B, Rottenstreich A, Grisaru-Granovsky S (2020) Vacuumextractiondeliveryatfirstvaginalbirth following cesarean: maternal and neonatal outcome. Arch Gynecol Obstet 301(2):483–489. https://doi.org/10.1007/s00404-020-05443-3
Guise J-M, Denman MA, Emeis C, Marshall N, Walker M, Fu R, Janik R, Nygren P, Eden KB, McDonagh M (2010) Vaginal birth after cesarean: new insights on maternal and neonatal outcomes. Obstet Gynecol 115(6):1267–1278. https://doi.org/10.1097/AOG.0b013e3181df925f
Rottenstreich M, Rotem R, Hirsch A, Farkash R, Rottenstreich A, Samueloff A, Sela HY (2019) Delayed diagnosis of intrapartum uterine rupture–maternal and neonatal consequences. J Matern Neonatal Med. https://doi.org/10.1080/14767058.2019.1613366
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Rottenstreich, M., Rotem, R. Response to: vacuum assisted vaginal birth after cesarean: the indication for vacuum assistance matters. Arch Gynecol Obstet 305, 795 (2022). https://doi.org/10.1007/s00404-021-06035-5
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DOI: https://doi.org/10.1007/s00404-021-06035-5