title: Can Intrapartum Cardiotocography Predict Uterine Rupture among Women with Prior Caesarean Delivery?: A Population Based Case-Control Study.
abstract: OBJECTIVE
  To compare cardiotocographic abnormalities recorded during labour in women with prior caesarean delivery (CD) and complete uterine rupture with those recorded in controls with prior CD without uterine rupture.
  
  
  METHODS
  Women with complete uterine rupture during labour between 1997 and 2008 were identified in the Danish Medical Birth Registry (n = 181). Cases were validated by review of medical records and 53 cases with prior CD, trial of labour, available cardiotocogram (CTG) and complete uterine rupture were included and compared with 43 controls with prior CD, trial of labour and available CTG. The CTG tracings were assessed by 19 independent experts divided into groups of three different experts for each tracing. The assessors were blinded to group, outcome and clinical data. They analyzed occurrence of defined abnormalities and classified the traces as normal, suspicious, pathological or pre-terminal according to international guidelines (FIGO).
  
  
  RESULTS
  A pathological CTG during the first stage of labour was present in 77% of cases and in 53% of the controls (OR 2.58 [CI: 0.96-6.94] P = 0.066). Fetal tachycardia was more frequent in cases with uterine rupture (OR 2.50 [CI: 1.0-6.26] P = 0.053). Significantly more cases showed more than 10 severe variable decelerations compared with controls (OR 22 [CI: 1.54-314.2] P = 0.022). Uterine tachysystole was not correlated with the presence of uterine rupture.
  
  
  CONCLUSIONS
  A pathological cardiotocogram should lead to particular attention on threatening uterine rupture but cannot be considered a strong predictor as it is common in all women with trial of labour after caesarean delivery.
authors.affiliation: Dept. of Obstetrics and Gynaecology, University of Copenhagen, Holbaek Hospital, Holbaek, Denmark.
authors.forename: Malene M
authors.initials: MM
authors.lastname: Andersen
authors.affiliation: Dept. of Obstetrics and Gynaecology, University of Copenhagen, Holbaek Hospital, Holbaek, Denmark.|University of Copenhagen, Hvidovre Hospital, Dept. of Obstetric and Gynecology, Hvidovre, Denmark.
authors.forename: Dorthe L A
authors.initials: DL
authors.lastname: Thisted
authors.affiliation: Dept. of Women and Child Health, Karolinska Institute, Stockholm, Sweden.
authors.forename: Isis
authors.initials: I
authors.lastname: Amer-Wåhlin
authors.affiliation: Dept. of Obstetrics and Gynaecology, University of Copenhagen, Holbaek Hospital, Holbaek, Denmark.
authors.forename: Lone
authors.initials: L
authors.lastname: Krebs
mesh_terms: D000328:Adult; D015148:Cardiotocography / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000503:physiopathology; D005318:Fetal Heart / Q000254:growth & development / Q000503:physiopathology; D005323:Fetal Monitoring / Q000295:instrumentation / Q000379:methods; D005333:Fetus; D006801:Humans; D007743:Labor, Obstetric; D011247:Pregnancy; D012042:Registries; D013610:Tachycardia / Q000175:diagnosis* / Q000503:physiopathology; D014597:Uterine Rupture / Q000175:diagnosis* / Q000517:prevention & control; D014599:Uterus / Q000473:pathology*; D016064:Vaginal Birth after Cesarean