Prediction of uterine rupture associated with attempted vaginal birth after cesarean delivery.
OBJECTIVE
The purpose of this study was to develop a model that predicts individual-specific risk of uterine rupture during an attempted vaginal birth after cesarean delivery.


METHODS
Women with 1 previous low-transverse cesarean delivery who underwent a trial of labor with a term singleton were identified in a concurrently collected database of deliveries that occurred at 19 academic centers during a 4-year period. We analyzed different classification techniques in an effort to develop an accurate prediction model for uterine rupture.


RESULTS
Of the 11,855 women who were available for analysis, 83 women (0.7%) had had a uterine rupture. The optimal final prediction model, which was based on a logistic regression, included 2 variables: any previous vaginal delivery (odds ratio, 0.44; 95% CI, 0.27-0.71) and induction of labor (odds ratio, 1.73; 95% CI, 1.11-2.69). This model, with a c-statistic of 0.627, had poor discriminating ability and did not allow the determination of a clinically useful estimate of the probability of uterine rupture for an individual patient.


CONCLUSIONS
Factors that were available before or at admission for delivery cannot be used to predict accurately the relatively small proportion of women at term who will experience a uterine rupture during an attempted vaginal birth after cesarean delivery.
Grobman
William A
WA
Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA. w-grobman@northwestern.edu
Lai
Yinglei
Y
Landon
Mark B
MB
Spong
Catherine Y
CY
Leveno
Kenneth J
KJ
Rouse
Dwight J
DJ
Varner
Michael W
MW
Moawad
Atef H
AH
Caritis
Steve N
SN
Harper
Margaret
M
Wapner
Ronald J
RJ
Sorokin
Yoram
Y
Miodovnik
Menachem
M
Carpenter
Marshall
M
O'Sullivan
Mary J
MJ
Sibai
Baha M
BM
Langer
Oded
O
Thorp
John M
JM
Ramin
Susan M
SM
Mercer
Brian M
BM
D000328:Adult; D005260:Female; D005544:Forecasting; D006801:Humans; D012307:Risk Factors; D014597:Uterine Rupture / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects*