title: Severe maternal and perinatal outcomes from uterine rupture among women at term with a trial of labor.
abstract: OBJECTIVE
  To describe maternal and perinatal morbidity and mortality associated with uterine rupture (UR) among women with prior cesarean/s, singleton term pregnancies and a trial of labor after cesarean (TOLAC).
  
  
  METHODS
  Linked hospital discharge files and birth/fetal death certificates identified potential cases of UR in Massachusetts from 1990 to 1998 with definitive identification by medical record abstraction.
  
  
  RESULTS
  Among the 347 identified URs, severe outcomes occurred in 86 cases (25%), in 49 (14%) of mothers and 49 (14%) of infants. Of the infants, 25 were discharged with a good prognosis. Maternal age and interdelivery interval <18 months (relative risk (RR)=1.55; 95% confidence interval (CI): 1.05, 2.31) were associated with a severe outcome. The type of hospital and labor were not associated with the increased risk of a severe outcome.
  
  
  CONCLUSIONS
  Assuming a 0.7% UR rate among women at term with a TOLAC, the increased rate of severe outcomes related to UR above the baseline risk of elective cesarean is estimated to be 1.3 per 1000 TOLACs.
authors.affiliation: Family Health Care Nursing, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: M K
authors.initials: MK
authors.lastname: Barger
authors.forename: A
authors.initials: A
authors.lastname: Nannini
authors.forename: J
authors.initials: J
authors.lastname: Weiss
authors.forename: E R
authors.initials: ER
authors.lastname: Declercq
authors.forename: P
authors.initials: P
authors.lastname: Stubblefield
authors.forename: M
authors.initials: M
authors.lastname: Werler
authors.forename: S
authors.initials: S
authors.lastname: Ringer
mesh_terms: D001034:Apgar Score; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008404:Massachusetts / Q000453:epidemiology; D008423:Maternal Age; D063130:Maternal Death / Q000706:statistics & numerical data*; D011247:Pregnancy; D011379:Prognosis; D012307:Risk Factors; D014219:Trial of Labor; D014597:Uterine Rupture / Q000453:epidemiology / Q000401:mortality*; D016064:Vaginal Birth after Cesarean