title: [Uterine rupture: prediction, diagnosis et management].
abstract: OBJECTIVE
  To evaluate predictors of uterine rupture (UR) after previous cesarean birth. To define the diagnosic criteria of UR, management and prognosis of subsequent pregnancies.
  
  
  METHODS
  Analysis of Medline database(®), Cochrane Library Database(®) and international guidelines.
  
  
  RESULTS
  Uterine rupture is a serious complication both for mother (mortality<1 %, severe morbidity 15 %) and child (mortality at term 3-6%, perinatal asphyxia 6-15%), occurring in 0,2 to 0,8 % of trial of labour after cesarean (TOLAC). The individual risk for UR after TOLAC is multifactorial and predictive scores showed no clinical utility in routine (grade B). The risk of UR is decreased in case of previous vaginal delivery and increased in case of classical C-section, previous UR, induction of labour (especially using prostaglandins), more than one previous caesarean section, fetal macrosomia and interval less than 6 months before the next pregnancy. Monitoring of labor, including intrauterine pressure catheters, do not allow to anticipate the diagnosis. This one relies on a combination of severe pathologic patterns of FHM with unusual pelvic pain. Suspected UR requires expedited laparotomy (consensus opinion). A subsequent pregnancy is not contraindicated, but the risk of recurrent UR is high and a repeat cesarean section is then recommended (grade B).
authors.affiliation: Inserm, UMR1027, 31073 Toulouse, France; Université de Toulouse III, UMR1027, 31073 Toulouse, France. olivier.parant@wanadoo.fr
authors.forename: O
authors.initials: O
authors.lastname: Parant
mesh_terms: D001721:Birth Intervals; D002585:Cesarean Section / Q000009:adverse effects*; D017604:Cesarean Section, Repeat / Q000009:adverse effects; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005320:Fetal Macrosomia / Q000150:complications; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects; D016239:MEDLINE; D007744:Obstetric Labor Complications; D011247:Pregnancy; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D014219:Trial of Labor; D014597:Uterine Rupture / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects