title: Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section.
abstract: OBJECTIVE
  To evaluate the incidence and consequences of uterine rupture in women who have had a delivery by caesarean section.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Medline, HealthSTAR, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, National Centre for Reviews and Dissemination, reference lists, and national experts. Studies in all languages were eligible if published in full.
  
  
  METHODS
  Methodological quality was evaluated for each study by using criteria from the United States Preventive Services Task Force and the National Health Service Centre for Reviews and Dissemination. Uterine rupture was categorised as asymptomatic or symptomatic.
  
  
  RESULTS
  We reviewed 568 full text articles to identify 71 potentially eligible studies, 21 of which were rated at least fair in quality. Compared with elective repeat caesarean delivery, trial of labour increased the risk of uterine rupture by 2.7 (95% confidence interval 0.73 to 4.73) per 1000 cases. No maternal deaths were related to rupture. For women attempting vaginal delivery, the additional risk of perinatal death from rupture of a uterine scar was 1.4 (0 to 9.8) per 10,000 and the additional risk of hysterectomy was 3.4 (0 to 12.6) per 10 000. The rates of asymptomatic uterine rupture in trial of labour and elective repeat caesarean did not differ significantly.
  
  
  CONCLUSIONS
  Although the literature on uterine rupture is imprecise and inconsistent, existing studies indicate that 370 (213 to 1370) elective caesarean deliveries would need to be performed to prevent one symptomatic uterine rupture.
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health & Science University, UHN-50, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA. guisej@ohsu.edu
authors.forename: Jeanne-Marie
authors.initials: JM
authors.lastname: Guise
authors.forename: Marian S
authors.initials: MS
authors.lastname: McDonagh
authors.forename: Patricia
authors.initials: P
authors.lastname: Osterweil
authors.forename: Peggy
authors.initials: P
authors.lastname: Nygren
authors.forename: Benjamin K S
authors.initials: BK
authors.lastname: Chan
authors.forename: Mark
authors.initials: M
authors.lastname: Helfand
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007751:Labor, Induced / Q000009:adverse effects; D009017:Morbidity; D010121:Oxytocin / Q000009:adverse effects; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D014219:Trial of Labor; D014597:Uterine Rupture / Q000453:epidemiology* / Q000209:etiology
chemical_list: D010121:Oxytocin