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

Mark B. Landon, Catherine Y. Spong, Elizabeth Thom, John C. Hauth, Steven L. Bloom, Michael W. Varner, Atef H. Moawad, Steve N. Caritis, 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. MercerSteven G. Gabbe

Research output: Contribution to journalArticle

147 Scopus citations

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.

Original languageEnglish
Pages (from-to)12-20
Number of pages9
JournalObstetrics and Gynecology
Volume108
Issue number1
DOIs
StatePublished - Jul 1 2006
Externally publishedYes

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ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Landon, M. B., Spong, C. Y., Thom, E., Hauth, J. C., Bloom, S. L., Varner, M. W., Moawad, A. H., Caritis, S. N., Harper, M., Wapner, R. J., Sorokin, Y., Miodovnik, M., Carpenter, M., Peaceman, A. M., O'Sullivan, M. J., Sibai, B. M., Langer, O., Thorp, J. M., Ramin, S. M., ... Gabbe, S. G. (2006). Risk of uterine rupture with a trial of labor in women with multiple and single prior cesarean delivery. Obstetrics and Gynecology, 108(1), 12-20. https://doi.org/10.1097/01.AOG.0000224694.32531.f3