Pregnancy after classic cesarean delivery.
OBJECTIVE
To describe maternal and perinatal outcomes after a prior classic cesarean delivery.


METHODS
A retrospective review was performed including all patients from 1990-2000 whose most recent pregnancy was preceded by classic cesarean delivery.


RESULTS
During the 11-year period, there were 37,863 deliveries and 157 patients (0.4%) underwent classic cesarean operations. In the next pregnancy, one case of uterine rupture (0.6%, 95% confidence interval 0.1, 3.5) occurred at 29 weeks without preterm labor and resulted in fetal death. The prevalence of asymptomatic dehiscence was 9% (95% confidence interval 5, 15). There was no significant difference between patients with uterine dehiscence (n = 15) and patients with intact uteri (n = 141) with regard to maternal demographics, duration of labor, cervical dilatation at time of surgery, transfusion of packed red cells, bowel injury, postpartum endometritis, wound breakdown, thrombophlebitis, or umbilical arterial pH less than 7.00 (P >.05). Duration of labor, cervical dilatation, and gestational age at repeat cesarean delivery were poor predictors for uterine rupture or dehiscence.


CONCLUSIONS
Among patients with prior classic cesarean delivery, uterine rupture and dehiscence are neither predictable nor preventable. One in four patients will experience some form of maternal morbidity. Uterine rupture, although infrequent, can be fatal to the fetus. Uterine dehiscence, however, does not increase neonatal or peripartum maternal morbidity.
Chauhan
Suneet P
SP
Spartanburg Regional Medical Center, Spartanburg, South Carolina 29303, USA. mfmchauhan@aol.com
Magann
Everett F
EF
Wiggs
Christopher D
CD
Barrilleaux
P Scott
PS
Martin
James N
JN
D002585:Cesarean Section; D005260:Female; D005313:Fetal Death / Q000209:etiology; D006801:Humans; D007743:Labor, Obstetric / Q000502:physiology; D011183:Postoperative Complications; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014591:Uterine Diseases / Q000209:etiology; D014597:Uterine Rupture / Q000209:etiology