309: Uterine rupture in women with previous cesarean for dystocia in second stage of labor

Abstract

for dystocia in second stage of labor Nicole Jastrow, Suzanne Demers, Robert J. Gauthier, Nils Chaillet, Normand Brassard, Emmanuel Bujold University Hospital of Geneva, Obstetrics and Gynecology, Geneva, Switzerland, University Laval, Obstetrics and Gynecology, Quebec, QC, Canada, University of Montreal, Obstetrics and Gynecology, Montreal, QC, Canada OBJECTIVE: To evaluate the risk of uterine rupture in women undergoing a trial of labor (TOL) after a previous cesarean for dystocia in second stage of labor. STUDY DESIGN: A retrospective cohort study of women with a single previous low-transverse cesarean undergoing a first TOL was performed. Women with a previous cesarean for dystocia in second stage were compared to those with previous dystocia in first stage and those with previous cesarean for non-recurrent reasons. Chi-square and Fishers exact were used when appropriate. RESULTS: Out of 1950 women, those with previous dystocia in second stage of labor (n 220) had a similar risk of uterine rupture than women with previous dystocia in the first stage (n 639) and women with previous cesarean for non-recurrent indication (1.8%, 1.7%, and 1.5%, respectively, p 0.88). However, we found that all (100%) uterine ruptures in the former group occurred in the second stage of labor (p 0.05) compared to 18% and 25% in the two other groups (p 0.05). The median length of the second stage of labor before uterine rupture was 2.5 hours (interquartile: 1.5 3.2 hours) for those cases. CONCLUSION: Previous cesarean for dystocia in the second stage of labor is associated with uterine rupture in the second stage of the subsequent delivery. This may be related to a lower location of the uterine scar, which may be more prone to rupture at an advanced cervical dilatation during the next delivery. Prolonged second stage should be avoided in these women.