Uterine Rupture Risk During Labor in Woman with History of Cesarean Section

 

Symptomatic uterine rupture involves:

(1) complete disruption of the cesarean section scar (as opposed to small dehiscences of the scar)

(2) one or more of the following: hemorrhage, need for hysterectomy, damage to the urinary bladder, extrusion of the placenta or fetus through the defect

 

Risk factors for symptomatic uterine rupture:

(1) maternal age >= 30 years

(2) infant birthweight >= 4,000 g

(3) induction, especially if prostaglandins are used

(4) more than 1 previous cesarean delivery

(5) interval since last cesarean delivery <= 18 months

Risk Factor	Odds Ratio	95% CI	Source
age >= 30	3.2	1.2 to 8.4	Shipp et al 2002
birthweight >= 4000 grams	1.6	0.7 to 3.9	Shipp et al 2002
induction	4.1	1.7 to 9.8	Shipp et al 2002
induction with prostaglandins	15.6	8.1 to 30.0	Lydon-Rochelle 2002
> 1 caesarean delivery	4.8		Caughey et al 1999
interval <= 18 months	2.6	1.1 to 6.1	Shipp et al 2002

 

where:

• The study looking at the interval since the last delivery involved women whose last delivery was a cesarean section and who had no history of a vaginal delivery. I am not sure what the risk would be for a woman who had a vaginal delivery <= 18 months before that followed a previous cesarean section.