Assessment of the rate of uterine rupture at the first prenatal visit: a preliminary evaluation.
OBJECTIVE
To quantify the risk for symptomatic uterine rupture during a trial of labor after prior cesarean delivery based on factors that can be ascertained during early pregnancy.


METHODS
From all trials of labor over a 12-year period, we determined those factors associated with an increased or decreased risk for uterine rupture and assigned scores. The following numerical scores were used: 2 points for > or = 2 prior cesarean scars, 1 point for interdelivery interval < or = 18 months, 1 point for maternal age of 30-39 years, 2 points for maternal age > or = 40 years, minus 1 point for women with prior vaginal delivery and one prior cesarean.


RESULTS
There were 40 uterine ruptures in 4383 trials of labor (0.91%). Overall, the rate of uterine rupture varied by score: -1-0.26% (1/391), 0-0.25% (4/1613), 1-1.11% (21/1894), 2-2.43% (9/370), 3-3.70% (4/108), and 4-14.29% (1/7), p = .001.


CONCLUSIONS
The rate of symptomatic uterine rupture during a trial of labor varies greatly depending on easily identified risk factors, and is low for women without risk factors.
Shipp
Thomas D
TD
Department of Obstetrics and Gynecology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. tshipp@partners.org
Zelop
Carolyn
C
Lieberman
Ellice
E
D000328:Adult; D005260:Female; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D011247:Pregnancy; D011295:Prenatal Care; D012307:Risk Factors; D014219:Trial of Labor; D014597:Uterine Rupture / Q000209:etiology*