Risk of Uterine Rupture and Adverse Perinatal Outcome at Term After Cesarean Delivery.

Spong, C. Y., Landon, M. B., Gilbert, S., Rouse, D. J., Leveno, K. J., Varner, M. W., et al. (2007). Risk of uterine rupture and adverse perinatal outcome at term after cesarean delivery. Obstet Gynecol, 110(4), 801-807.

Another study on uterine rupture and below is an excerpt from the abstract:

RESULTS: A total of 39,117 women were studied. In term pregnantwomen with a prior cesarean delivery, the overall risk for uterinerupture was 0.32% (125 of 39,117), and the overall risk forserious adverse perinatal outcome (stillbirth, hypoxic ischemicencephalopathy, neonatal death) was 106 of 39,049 (0.27%). Theuterine rupture risk for indicated repeat cesarean delivery(labor or without labor) was 7 of 6,080 (0.12%); the risk forelective (no indication) repeat cesarean delivery (labor orwithout labor) was 4 of 17,714 (0.02%). Indicated repeat cesareandelivery increased the risk of uterine rupture by a factor of5 (odds ratio 5.1, 95% confidence interval 1.49–17.44).In the absence of an indication, the presence of labor alsoincreased the risk of uterine rupture (4 of 2,721 [0.15%] comparedwith 0 of 14,993, P<.01). The highest rate of uterine ruptureoccurred in women undergoing trial of labor (0.74%, 114 of 15,323).

CONCLUSION: At term, the risk of uterine rupture and adverseperinatal outcome for women with a singleton and prior cesareandelivery is low regardless of mode of delivery, occurring in3 per 1,000 women. Maternal complications occurred in 3–8%of women within the five delivery groups.

Since we know that VBAC labors that are induced or augmented have higher rupture rates, I wonder if they broke out the difference in uterine rupture rates for spontaneous labors.  This study is consistent with the Landon 2004 study which found an overall rupture rate of 0.7%.  However, if you read the entire Landon 2004 study, you will see that rupture rates for spontaneous labors were 0.4% – almost half.

I really wish when studies like this are published, that they would include this type of information in their results.  It is important for women researching VBAC to have a complete understanding of how consenting to an induction, or permitting their labor to be augmented with oxytocin, affects their risk for uterine rupture.

I would also like to know what they consider a “maternal complication.”  My post-partum hemorrhage at my homebirth VBAC would certainly be considered a complication… and it was a complication that was handled safely at home.  I think it’s important for women to know that “complication” does not equal “going to the hospital” or even “it’s safer to be in the hospital.”  Because remember, simply being in the hospital increases your risk of complications.

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