Previous preterm cesarean delivery: identification of a new risk factor for uterine rupture in VBAC candidates.
OBJECTIVE
A major risk of trials of labor in patients with prior cesarean delivery is uterine rupture. We evaluated the question of whether a previous cesarean delivery at an early gestational age predisposes the patient to subsequent uterine rupture.


METHODS
This was a retrospective chart review of patients delivering at North Shore University Hospital with a trial of labor after previous cesarean delivery to ascertain all cases of uterine rupture. Patients who had had a previous cesarean delivery at our institution who did not suffer uterine rupture during a trial of labor served as controls.


RESULTS
Twenty-five patients suffered a uterine rupture. The incidence of prior preterm cesarean delivery (PPCD) in this group was 40%, compared to 10.9% of 691 laboring vaginal birth after cesarean (VBAC) patients without rupture (p < 0.001). Patients in the rupture group with a PPCD were less likely to have experienced labor in the index pregnancy and more likely to have had an interdelivery interval of less than two years.


CONCLUSIONS
An undeveloped lower segment in the preterm uterus represents a risk for later rupture, even if the incision is transverse.
Rochelson
Burton
B
Department of Obstetrics and Gynecology, North Shore University Hospital, Manhasset, NY 11030, USA. brochels@nshs.edu
Pagano
Michelle
M
Conetta
Laurie
L
Goldman
Benjamin
B
Vohra
Nidhi
N
Frey
Michael
M
Day
Catherine
C
D001721:Birth Intervals; D016022:Case-Control Studies; D002585:Cesarean Section; D005260:Female; D005865:Gestational Age; D006801:Humans; D010120:Oxytocics / Q000627:therapeutic use; D011247:Pregnancy; D047928:Premature Birth; D012189:Retrospective Studies; D012307:Risk Factors; D014219:Trial of Labor; D014597:Uterine Rupture; D016064:Vaginal Birth after Cesarean
D010120:Oxytocics