Clinical significance of uterine scar dehiscence in women with previous cesarean delivery: prevalence and independent risk factors.
OBJECTIVE
To determine the prevalence and risk factors for uterine scar dehiscence in women following cesarean delivery (CD).


METHODS
Our computerized database was used to identify patients with recurrent CDs in the index pregnancy (1988-2002). Women with uterine dehiscence were compared to those without dehiscence. Multiple logistic regression analysis was used to determine independent risk factors for dehiscence.


RESULTS
Of 7,833 women with at least 1 previous CD and a CD in the index pregnancy, 81 (1.03%) had uterine scar dehiscence. This finding was associated with nonprogress of labor during the first stage, number of previous CDs, parity, preterm delivery and low Apgar scores at 5 minutes. For patients with only 1 previous CD, failure to progress during the first stage of labor and lower parity were associated with uterine scar dehiscence. The numbers of previous CDs, gravidity and placenta previa rate were significantly higher in the group with dehiscence who delivered preterm.


CONCLUSIONS
Preterm delivery, nonprogress of labor during the first stage and number of previous CDs were found to be independent risk factors for uterine scar dehiscence. In contrast, parity had a protective effect against dehiscence.
Bashiri
Asher
A
Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel. abashiri@bgu.ac.il
Burstein
Eliezer
E
Rosen
Shirly
S
Smolin
Ana
A
Sheiner
Eyal
E
Mazor
Moshe
M
D000328:Adult; D001034:Apgar Score; D017604:Cesarean Section, Repeat / Q000009:adverse effects*; D005260:Female; D005865:Gestational Age; D020073:Gravidity; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D008423:Maternal Age; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D015995:Prevalence; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000453:epidemiology* / Q000209:etiology; D014219:Trial of Labor; D014591:Uterine Diseases / Q000453:epidemiology / Q000209:etiology; D014592:Uterine Hemorrhage / Q000453:epidemiology / Q000209:etiology; D014597:Uterine Rupture / Q000453:epidemiology / Q000209:etiology