title: Fetal heart rate abnormalities associated with uterine rupture: a case-control study: A new time-lapse approach using a standardized classification.
abstract: OBJECTIVE
  The aim of this study was to identify fetal heart rate abnormalities (FHRA) in the two hours preceding uterine rupture during trial of labor after a previous C-section compared with successful vaginal birth after cesarean controls.
  
  
  METHODS
  A multicenter case-control study was conducted from 2006 to 2012. Fetal heart rate tracings of the two-hour period preceding delivery were segmented, anonymized and independently classified by two obstetricians according to a standardized grid based on FIGO guidelines (4 grades: 1 - normal, 2 - intermediate, 3 - abnormal, 4 - preterminal). Each case of uterine rupture was matched to 2 controls. Survival curves were generated for both groups using the Kaplan-Meier method to analyze the occurrence of each FHR category across time.
  
  
  RESULTS
  During the study period, 39,773 patients gave birth. 2649 involved women with a previous C-section (6.6%). A total of 33 uterine rupture/scar dehiscence cases occurred (0.08% of all births), of which 22 were included. These were matched to 44 controls. FIGO grade-3 FHRA were significantly associated with uterine rupture in the hour preceding its diagnosis: odds ratios were 4.1 (95% CI 1.2-14.0), 4.3 (95% CI 1.4-13.0) and 3.7 (95% CI 1.2-11.3), in the 60-40 min, 40-20 min and last 20 min before childbirth, respectively. Agreement between the two reviewers (Cohen's kappa) was 84% (CI 95%: 0.79-0.89).
  
  
  CONCLUSIONS
  In the hour preceding uterine rupture, there are often significant FHRA. This leads us to consider the possibility of an earlier C-section when faced with grade-3 FHRA, before the onset of terminal bradycardia jeopardizing maternal and fetal prognosis.
authors.affiliation: Université de Poitiers, Faculté de Médecine et Pharmacie, 2 rue de la Milétrie, F-86000 Poitiers, France; Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, F-86000 Poitiers, France. Electronic address: david.desseauve@chu-poitiers.fr.
authors.forename: David
authors.initials: D
authors.lastname: Desseauve
authors.affiliation: Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, F-86000 Poitiers, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Bonifazi-Grenouilleau
authors.affiliation: Université de Poitiers, Faculté de Médecine et Pharmacie, 2 rue de la Milétrie, F-86000 Poitiers, France; Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, F-86000 Poitiers, France; Inserm CIC0802, 2 rue de la Milétrie, F-86000 Poitiers, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Fritel
authors.affiliation: Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, F-86000 Poitiers, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Lathélize
authors.affiliation: Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, F-86000 Poitiers, France.
authors.forename: Mélie
authors.initials: M
authors.lastname: Sarreau
authors.affiliation: Université de Poitiers, Faculté de Médecine et Pharmacie, 2 rue de la Milétrie, F-86000 Poitiers, France; Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, F-86000 Poitiers, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Pierre
mesh_terms: D000328:Adult; D001919:Bradycardia / Q000453:epidemiology*; D016022:Case-Control Studies; D005260:Female; D005315:Fetal Diseases / Q000453:epidemiology*; D006340:Heart Rate, Fetal; D006801:Humans; D053208:Kaplan-Meier Estimate; D016017:Odds Ratio; D011247:Pregnancy; D018570:Risk Assessment; D013610:Tachycardia / Q000453:epidemiology*; D013997:Time Factors; D014219:Trial of Labor; D014597:Uterine Rupture / Q000453:epidemiology*; D016064:Vaginal Birth after Cesarean
keywords: Fetal heart rate; Risk management; Trial of labor after C-section (TOLAC); Uterine rupture