Risk of uterine rupture and adverse perinatal outcome at term after cesarean delivery

Catherine Y. Spong, Mark B. Landon, Sharon Gilbert, Dwight J. Rouse, Kenneth J. Leveno, Michael W. Varner, Atef H. Moawad, Hyagriv N. Simhan, Margaret Harper, Ronald J. Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Alan M. Peaceman, Mary J. O'Sullivan, Baha M. Sibai, Oded Langer, John M. Thorp, Susan M. Ramin, Brian M. Mercer

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

OBJECTIVE: Current information on the risk of uterine rupture after cesarean delivery has generally compared the risk after trial of labor to that occurring with an elective cesarean delivery without labor. Because antepartum counseling cannot account for whether a woman will develop an indication requiring a repeat cesarean delivery or whether labor will occur before scheduled cesarean delivery, the purpose of this analysis was to provide clinically useful information regarding the risks of uterine rupture and adverse perinatal outcome for women at term with a history of prior cesarean delivery. METHODS: Women with a term singleton gestation and prior cesarean delivery were studied over 4 years at 19 centers. For this analysis, outcomes from five groups were studied: trial of labor, elective repeat with no labor, elective repeat with labor (women presenting in early labor who subsequently underwent cesarean delivery), indicated repeat with labor, and indicated repeat without labor. All cases of uterine rupture were reviewed centrally to assure accuracy of diagnosis. RESULTS: A total of 39,117 women were studied. In term pregnant women with a prior cesarean delivery, the overall risk for uterine rupture was 0.32% (125 of 39,117), and the overall risk for serious adverse perinatal outcome (stillbirth, hypoxic ischemic encephalopathy, neonatal death) was 106 of 39,049 (0.27%). The uterine rupture risk for indicated repeat cesarean delivery (labor or without labor) was 7 of 6,080 (0.12%); the risk for elective (no indication) repeat cesarean delivery (labor or without labor) was 4 of 17,714 (0.02%). Indicated repeat cesarean delivery increased the risk of uterine rupture by a factor of 5 (odds ratio 5.1, 95% confidence interval 1.49-17.44). In the absence of an indication, the presence of labor also increased the risk of uterine rupture (4 of 2,721 [0.15%] compared with 0 of 14,993, P<.01). The highest rate of uterine rupture occurred in women undergoing trial of labor (0.74%, 114 of 15,323). CONCLUSION: At term, the risk of uterine rupture and adverse perinatal outcome for women with a singleton and prior cesarean delivery is low regardless of mode of delivery, occurring in 3 per 1,000 women. Maternal complications occurred in 3-8% of women within the five delivery groups.

Original languageEnglish
Pages (from-to)801-807
Number of pages7
JournalObstetrics and Gynecology
Volume110
Issue number4
DOIs
StatePublished - Oct 1 2007
Externally publishedYes

Fingerprint

Uterine Rupture
Trial of Labor
Brain Hypoxia-Ischemia
Stillbirth
Counseling
Pregnant Women
Odds Ratio
Mothers
Confidence Intervals

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Spong, C. Y., Landon, M. B., Gilbert, S., Rouse, D. J., Leveno, K. J., Varner, M. W., ... Mercer, B. M. (2007). Risk of uterine rupture and adverse perinatal outcome at term after cesarean delivery. Obstetrics and Gynecology, 110(4), 801-807. https://doi.org/10.1097/01.AOG.0000284622.71222.b2

Risk of uterine rupture and adverse perinatal outcome at term after cesarean delivery. / Spong, Catherine Y.; Landon, Mark B.; Gilbert, Sharon; Rouse, Dwight J.; Leveno, Kenneth J.; Varner, Michael W.; Moawad, Atef H.; Simhan, Hyagriv N.; Harper, Margaret; Wapner, Ronald J.; Sorokin, Yoram; Miodovnik, Menachem; Carpenter, Marshall; Peaceman, Alan M.; O'Sullivan, Mary J.; Sibai, Baha M.; Langer, Oded; Thorp, John M.; Ramin, Susan M.; Mercer, Brian M.

In: Obstetrics and Gynecology, Vol. 110, No. 4, 01.10.2007, p. 801-807.

Research output: Contribution to journalArticle

Spong, CY, Landon, MB, Gilbert, S, Rouse, DJ, Leveno, KJ, Varner, MW, Moawad, AH, Simhan, HN, 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 2007, 'Risk of uterine rupture and adverse perinatal outcome at term after cesarean delivery', Obstetrics and Gynecology, vol. 110, no. 4, pp. 801-807. https://doi.org/10.1097/01.AOG.0000284622.71222.b2
Spong, Catherine Y. ; Landon, Mark B. ; Gilbert, Sharon ; Rouse, Dwight J. ; Leveno, Kenneth J. ; Varner, Michael W. ; Moawad, Atef H. ; Simhan, Hyagriv N. ; Harper, Margaret ; Wapner, Ronald J. ; Sorokin, Yoram ; Miodovnik, Menachem ; Carpenter, Marshall ; Peaceman, Alan M. ; O'Sullivan, Mary J. ; Sibai, Baha M. ; Langer, Oded ; Thorp, John M. ; Ramin, Susan M. ; Mercer, Brian M. / Risk of uterine rupture and adverse perinatal outcome at term after cesarean delivery. In: Obstetrics and Gynecology. 2007 ; Vol. 110, No. 4. pp. 801-807.
@article{3ff78ec78f2d488c92adc3c8baaa683e,
title = "Risk of uterine rupture and adverse perinatal outcome at term after cesarean delivery",
abstract = "OBJECTIVE: Current information on the risk of uterine rupture after cesarean delivery has generally compared the risk after trial of labor to that occurring with an elective cesarean delivery without labor. Because antepartum counseling cannot account for whether a woman will develop an indication requiring a repeat cesarean delivery or whether labor will occur before scheduled cesarean delivery, the purpose of this analysis was to provide clinically useful information regarding the risks of uterine rupture and adverse perinatal outcome for women at term with a history of prior cesarean delivery. METHODS: Women with a term singleton gestation and prior cesarean delivery were studied over 4 years at 19 centers. For this analysis, outcomes from five groups were studied: trial of labor, elective repeat with no labor, elective repeat with labor (women presenting in early labor who subsequently underwent cesarean delivery), indicated repeat with labor, and indicated repeat without labor. All cases of uterine rupture were reviewed centrally to assure accuracy of diagnosis. RESULTS: A total of 39,117 women were studied. In term pregnant women with a prior cesarean delivery, the overall risk for uterine rupture was 0.32{\%} (125 of 39,117), and the overall risk for serious adverse perinatal outcome (stillbirth, hypoxic ischemic encephalopathy, neonatal death) was 106 of 39,049 (0.27{\%}). The uterine rupture risk for indicated repeat cesarean delivery (labor or without labor) was 7 of 6,080 (0.12{\%}); the risk for elective (no indication) repeat cesarean delivery (labor or without labor) was 4 of 17,714 (0.02{\%}). Indicated repeat cesarean delivery increased the risk of uterine rupture by a factor of 5 (odds ratio 5.1, 95{\%} confidence interval 1.49-17.44). In the absence of an indication, the presence of labor also increased the risk of uterine rupture (4 of 2,721 [0.15{\%}] compared with 0 of 14,993, P<.01). The highest rate of uterine rupture occurred in women undergoing trial of labor (0.74{\%}, 114 of 15,323). CONCLUSION: At term, the risk of uterine rupture and adverse perinatal outcome for women with a singleton and prior cesarean delivery is low regardless of mode of delivery, occurring in 3 per 1,000 women. Maternal complications occurred in 3-8{\%} of women within the five delivery groups.",
author = "Spong, {Catherine Y.} and Landon, {Mark B.} and Sharon Gilbert and Rouse, {Dwight J.} and Leveno, {Kenneth J.} and Varner, {Michael W.} and Moawad, {Atef H.} and Simhan, {Hyagriv N.} and Margaret Harper and Wapner, {Ronald J.} and Yoram Sorokin and Menachem Miodovnik and Marshall Carpenter and Peaceman, {Alan M.} and O'Sullivan, {Mary J.} and Sibai, {Baha M.} and Oded Langer and Thorp, {John M.} and Ramin, {Susan M.} and Mercer, {Brian M.}",
year = "2007",
month = "10",
day = "1",
doi = "10.1097/01.AOG.0000284622.71222.b2",
language = "English",
volume = "110",
pages = "801--807",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Risk of uterine rupture and adverse perinatal outcome at term after cesarean delivery

AU - Spong, Catherine Y.

AU - Landon, Mark B.

AU - Gilbert, Sharon

AU - Rouse, Dwight J.

AU - Leveno, Kenneth J.

AU - Varner, Michael W.

AU - Moawad, Atef H.

AU - Simhan, Hyagriv N.

AU - Harper, Margaret

AU - Wapner, Ronald J.

AU - Sorokin, Yoram

AU - Miodovnik, Menachem

AU - Carpenter, Marshall

AU - Peaceman, Alan M.

AU - O'Sullivan, Mary J.

AU - Sibai, Baha M.

AU - Langer, Oded

AU - Thorp, John M.

AU - Ramin, Susan M.

AU - Mercer, Brian M.

PY - 2007/10/1

Y1 - 2007/10/1

N2 - OBJECTIVE: Current information on the risk of uterine rupture after cesarean delivery has generally compared the risk after trial of labor to that occurring with an elective cesarean delivery without labor. Because antepartum counseling cannot account for whether a woman will develop an indication requiring a repeat cesarean delivery or whether labor will occur before scheduled cesarean delivery, the purpose of this analysis was to provide clinically useful information regarding the risks of uterine rupture and adverse perinatal outcome for women at term with a history of prior cesarean delivery. METHODS: Women with a term singleton gestation and prior cesarean delivery were studied over 4 years at 19 centers. For this analysis, outcomes from five groups were studied: trial of labor, elective repeat with no labor, elective repeat with labor (women presenting in early labor who subsequently underwent cesarean delivery), indicated repeat with labor, and indicated repeat without labor. All cases of uterine rupture were reviewed centrally to assure accuracy of diagnosis. RESULTS: A total of 39,117 women were studied. In term pregnant women with a prior cesarean delivery, the overall risk for uterine rupture was 0.32% (125 of 39,117), and the overall risk for serious adverse perinatal outcome (stillbirth, hypoxic ischemic encephalopathy, neonatal death) was 106 of 39,049 (0.27%). The uterine rupture risk for indicated repeat cesarean delivery (labor or without labor) was 7 of 6,080 (0.12%); the risk for elective (no indication) repeat cesarean delivery (labor or without labor) was 4 of 17,714 (0.02%). Indicated repeat cesarean delivery increased the risk of uterine rupture by a factor of 5 (odds ratio 5.1, 95% confidence interval 1.49-17.44). In the absence of an indication, the presence of labor also increased the risk of uterine rupture (4 of 2,721 [0.15%] compared with 0 of 14,993, P<.01). The highest rate of uterine rupture occurred in women undergoing trial of labor (0.74%, 114 of 15,323). CONCLUSION: At term, the risk of uterine rupture and adverse perinatal outcome for women with a singleton and prior cesarean delivery is low regardless of mode of delivery, occurring in 3 per 1,000 women. Maternal complications occurred in 3-8% of women within the five delivery groups.

AB - OBJECTIVE: Current information on the risk of uterine rupture after cesarean delivery has generally compared the risk after trial of labor to that occurring with an elective cesarean delivery without labor. Because antepartum counseling cannot account for whether a woman will develop an indication requiring a repeat cesarean delivery or whether labor will occur before scheduled cesarean delivery, the purpose of this analysis was to provide clinically useful information regarding the risks of uterine rupture and adverse perinatal outcome for women at term with a history of prior cesarean delivery. METHODS: Women with a term singleton gestation and prior cesarean delivery were studied over 4 years at 19 centers. For this analysis, outcomes from five groups were studied: trial of labor, elective repeat with no labor, elective repeat with labor (women presenting in early labor who subsequently underwent cesarean delivery), indicated repeat with labor, and indicated repeat without labor. All cases of uterine rupture were reviewed centrally to assure accuracy of diagnosis. RESULTS: A total of 39,117 women were studied. In term pregnant women with a prior cesarean delivery, the overall risk for uterine rupture was 0.32% (125 of 39,117), and the overall risk for serious adverse perinatal outcome (stillbirth, hypoxic ischemic encephalopathy, neonatal death) was 106 of 39,049 (0.27%). The uterine rupture risk for indicated repeat cesarean delivery (labor or without labor) was 7 of 6,080 (0.12%); the risk for elective (no indication) repeat cesarean delivery (labor or without labor) was 4 of 17,714 (0.02%). Indicated repeat cesarean delivery increased the risk of uterine rupture by a factor of 5 (odds ratio 5.1, 95% confidence interval 1.49-17.44). In the absence of an indication, the presence of labor also increased the risk of uterine rupture (4 of 2,721 [0.15%] compared with 0 of 14,993, P<.01). The highest rate of uterine rupture occurred in women undergoing trial of labor (0.74%, 114 of 15,323). CONCLUSION: At term, the risk of uterine rupture and adverse perinatal outcome for women with a singleton and prior cesarean delivery is low regardless of mode of delivery, occurring in 3 per 1,000 women. Maternal complications occurred in 3-8% of women within the five delivery groups.

UR - http://www.scopus.com/inward/record.url?scp=34848911065&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34848911065&partnerID=8YFLogxK

U2 - 10.1097/01.AOG.0000284622.71222.b2

DO - 10.1097/01.AOG.0000284622.71222.b2

M3 - Article

C2 - 17906012

AN - SCOPUS:34848911065

VL - 110

SP - 801

EP - 807

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 4

ER -