Post-cesarean delivery fever and uterine rupture in a subsequent trial of labor.
OBJECTIVE
To evaluate the association of uterine rupture during a trial of labor after cesarean with postpartum fever after the prior cesarean delivery.


METHODS
We conducted a nested, case-control study in a cohort of all women undergoing a trial of labor after cesarean over a 12-year period in a single tertiary care institution. The current study was limited to all women undergoing a trial of labor after cesarean at term with a symptomatic uterine rupture and who also had their prior cesarean at the same institution. Four controls, who all had their prior cesarean at the same institution, were matched to each case by year of delivery, number of prior cesareans, prior vaginal delivery, and induction in the index pregnancy. Medical records were reviewed for maximum postpartum temperature for the previous cesarean. Fever was defined as a temperature above 38C. Conditional logistic regression analysis was performed taking into account potential confounding factors.


RESULTS
There were 21 cases of uterine rupture included in the analysis. The rate of fever following the prior cesarean was 38% (8/21) among the cases, and 15% (13/84) in the controls, P =.03. Multiple logistic regression analysis examining the association of uterine rupture and postpartum fever adjusting for confounders revealed an odds ratio of 4.0, 95% confidence interval 1.0, 15.5.


CONCLUSIONS
Postpartum fever after cesarean delivery is associated with an increased risk of uterine rupture during a subsequent trial of labor.
Shipp
Thomas D
TD
Department of Obstetrics and Gynecology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. tshipp@partners.org
Zelop
Carolyn
C
Cohen
Amy
A
Repke
John T
JT
Lieberman
Ellice
E
D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D011645:Puerperal Infection / Q000453:epidemiology*; D012307:Risk Factors; D014219:Trial of Labor; D014597:Uterine Rupture / Q000453:epidemiology*