A woman who has had a previous cesarean section is at risk for uterine rupture during future deliveries. The presence of symptomatic rupture is associated with increased risk of maternal and/or neonatal morbidity and mortality. While the absolute risk is low, a woman with significant risk factors for symptomatic rupture should be managed more carefully.


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


age >= 30


1.2 to 8.4

Shipp et al 2002

birthweight >= 4000 grams


0.7 to 3.9

Shipp et al 2002



1.7 to 9.8

Shipp et al 2002

induction with prostaglandins


8.1 to 30.0

Lydon-Rochelle 2002

> 1 caesarean delivery



Caughey et al 1999

interval <= 18 months


1.1 to 6.1

Shipp et al 2002



• 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.


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