title: [Risk of uterine rupture after cesarean section--analysis of 1,086 births].
abstract: OBJECTIVE
  In the presented paper, obstetrical management after previous caesarian section was studied in a large patient collective at the University Department of Gynaecology and Obstetrics in Cologne from 1979 to 1995. Particular attention was given to the feared complication of rupture of the uterus.
  
  
  METHODS
  From a total of 15,166 deliveries, 1,086 of the births had been preceded by one or more caesarian section. These 1,086 births formed the patient collective for the present study.
  
  
  RESULTS
  Vaginal delivery was attempted in 44.5% of patients and was successful in 86% of those cases. If there had been a previous caesarian section, the percentage shifted in favour of vaginal delivery. All patients with more than two previous caesarian sections were delivered by a primary caesarian section. The feared complication of rupture of the uterus occurred in four cases, for which case reports are presented. In view of such cases, signs of imminent uterus rupture often constitute an indication for primary (11.5%) or secondary resectioning (31.9%). No relationship was found between fetal outcome and mode of delivery.
  
  
  CONCLUSIONS
  This retrospective study confirms the general recommendation of vaginal delivery following previous caesarian section as long as risks are minimized by a readiness to proceed with resectioning when signs of imminent rupture of the uterus arise.
authors.affiliation: St. Josefshospital Krefeld.
authors.forename: W
authors.initials: W
authors.lastname: Neuhaus
authors.forename: G
authors.initials: G
authors.lastname: Bauerschmitz
authors.forename: U
authors.initials: U
authors.lastname: Göhring
authors.forename: T
authors.initials: T
authors.lastname: Schmidt
authors.forename: A
authors.initials: A
authors.lastname: Bolte
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000706:statistics & numerical data; D000075202:Contraindications; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014597:Uterine Rupture / Q000175:diagnosis / Q000453:epidemiology*; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects* / Q000706:statistics & numerical data