Dystocia among women with symptomatic uterine rupture.
OBJECTIVE
The purpose of this study was to analyze cervical dilatation patterns among women with uterine rupture by means of a mathematic model and to use the results to determine optimal intervention criteria.


METHODS
This was a case-control review that compared a case patient group of 19 women with uterine rupture during labor with control groups with either no previous cesarean deliveries, vaginal birth after cesarean delivery, or failure of attempted vaginal birth after cesarean delivery. The mathematic model quantified dilatation and adjusted for conditions specific to each patient. Case patients were compared with matched control subjects by means of paired t tests, analysis of variance, odds ratios, and conditional logistic regression.


RESULTS
Dystocia was present in 31.6% to 47.4% of patients with uterine rupture, versus 2.6% to 13.2% of the control group with no previous cesarean deliveries (P< or =.001). The incidence of an arrest disorder among patients with uterine rupture was similar to that seen in the control group with failure of attempted vaginal birth after cesarean delivery. However, the interval from diagnosis to rupture or cesarean delivery was 5.5 +/- 3.3 hours among case patients with uterine rupture and 1.5 +/- 1.3 hours in the control group with failure of attempted vaginal birth after cesarean delivery.


CONCLUSIONS
When cervical dilatation was lower than the 10th percentile and was arrested for > or =2 hours, cesarean delivery would have prevented 42.1% of the cases of uterine rupture and resulted in excess 2.6% and 7.9% cesarean delivery rates among women with no previous cesarean deliveries and women with vaginal birth after cesarean delivery, respectively.
Hamilton
E F
EF
Department of Obstetrics and Gynecology, Royal Victoria Hospital and McGill University, Canada.
Bujold
E
E
McNamara
H
H
Gauthier
R
R
Platt
R W
RW
D016022:Case-Control Studies; D002584:Cervix Uteri / Q000503:physiopathology; D002585:Cesarean Section; D004420:Dystocia / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D007747:Labor Stage, First; D011247:Pregnancy; D014597:Uterine Rupture / Q000150:complications* / Q000503:physiopathology; D016064:Vaginal Birth after Cesarean