title: Risk of uterine rupture and adverse perinatal outcome at term after cesarean delivery.
abstract: OBJECTIVE
  Current information on the risk of uterine rupture after cesarean delivery has generally compared the risk after trial of labor to that occurring with an elective cesarean delivery without labor. Because antepartum counseling cannot account for whether a woman will develop an indication requiring a repeat cesarean delivery or whether labor will occur before scheduled cesarean delivery, the purpose of this analysis was to provide clinically useful information regarding the risks of uterine rupture and adverse perinatal outcome for women at term with a history of prior cesarean delivery.
  
  
  METHODS
  Women with a term singleton gestation and prior cesarean delivery were studied over 4 years at 19 centers. For this analysis, outcomes from five groups were studied: trial of labor, elective repeat with no labor, elective repeat with labor (women presenting in early labor who subsequently underwent cesarean delivery), indicated repeat with labor, and indicated repeat without labor. All cases of uterine rupture were reviewed centrally to assure accuracy of diagnosis.
  
  
  RESULTS
  A total of 39,117 women were studied. In term pregnant women with a prior cesarean delivery, the overall risk for uterine rupture was 0.32% (125 of 39,117), and the overall risk for serious adverse perinatal outcome (stillbirth, hypoxic ischemic encephalopathy, neonatal death) was 106 of 39,049 (0.27%). The uterine rupture risk for indicated repeat cesarean delivery (labor or without labor) was 7 of 6,080 (0.12%); the risk for elective (no indication) repeat cesarean delivery (labor or without labor) was 4 of 17,714 (0.02%). Indicated repeat cesarean delivery increased the risk of uterine rupture by a factor of 5 (odds ratio 5.1, 95% confidence interval 1.49-17.44). In the absence of an indication, the presence of labor also increased the risk of uterine rupture (4 of 2,721 [0.15%] compared with 0 of 14,993, P<.01). The highest rate of uterine rupture occurred in women undergoing trial of labor (0.74%, 114 of 15,323).
  
  
  CONCLUSIONS
  At term, the risk of uterine rupture and adverse perinatal outcome for women with a singleton and prior cesarean delivery is low regardless of mode of delivery, occurring in 3 per 1,000 women. Maternal complications occurred in 3-8% of women within the five delivery groups.
authors: National Institute of Child Health and Human Development, Bethesda, Maryland, USA. spongc@mail.nih.gov
authors: Catherine Y
authors: CY
authors: Spong
authors: Mark B
authors: MB
authors: Landon
authors: Sharon
authors: S
authors: Gilbert
authors: Dwight J
authors: DJ
authors: Rouse
authors: Kenneth J
authors: KJ
authors: Leveno
authors: Michael W
authors: MW
authors: Varner
authors: Atef H
authors: AH
authors: Moawad
authors: Hyagriv N
authors: HN
authors: Simhan
authors: Margaret
authors: M
authors: Harper
authors: Ronald J
authors: RJ
authors: Wapner
authors: Yoram
authors: Y
authors: Sorokin
authors: Menachem
authors: M
authors: Miodovnik
authors: Marshall
authors: M
authors: Carpenter
authors: Alan M
authors: AM
authors: Peaceman
authors: Mary J
authors: MJ
authors: O'Sullivan
authors: Baha M
authors: BM
authors: Sibai
authors: Oded
authors: O
authors: Langer
authors: John M
authors: JM
authors: Thorp
authors: Susan M
authors: SM
authors: Ramin
authors: Brian M
authors: BM
authors: Mercer
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors; D014597:Uterine Rupture / Q000453:epidemiology* / Q000209:etiology