Risk of uterine rupture among women in a trial of labor after prior cesarean delivery

Abstract

Uterine rupture during a trial of labor after prior cesarean (TOLAC) delivery is an obstetrical emergency with potentially severe adverse outcomes. The aim of this study was to assess the incidence of uterine rupture and adverse maternal and perinatal outcomes. We conducted a population-based, retrospective cohort analysis with data from all women who gave birth after one prior cesarean delivery at a single tertiary center from 2009 through 2019. Maternal and perinatal outcomes were compared between women who underwent a successful or failed TOLAC and elective repeated cesarean delivery (ERCD) without labor. Out of 95,552 deliveries, TOLAC was attempted by 5,619 (63.35%), while 3,250 (36.64%) women underwent ERCD. The rate of successful TOLAC - vaginal birth after cesarean (VBAC) was 81.92%. Symptomatic uterine rupture occurred in 55 (0.98%) women who underwent TOLAC and asymptomatic rupture in five (0.153%) who underwent ERCD. Compared with women with spontaneous onset of labor, a greater risk, albeit not significant, for uterine rupture was observed among women with induction of labor using prostaglandins (OR 2.44; CI 0.86-6.92), oxytocin (OR 2.16 CI 0.84-5.54), and lower when external amniotic balloon was used (OR 0.52; CI 0.07-3.86). Women who failed in TOLAC needed more blood transfusions (OR 6.06; CI 3.61-10.16, p< 0.011). Neonatal hypoxic–ischemic encephalopathy occurred in a single case of successful TOLAC but in none of the other groups. There were no cases of cesarean hysterectomy, maternal or neonatal death in any group. Our data confirm the relatively small risk of uterine rupture during TOLAC. In a tertiary well-trained center, with close maternal and fetal monitoring, uterine rupture is rare and does not result in severe maternal and neonatal morbidity or mortality.View Large Image Figure ViewerDownload Hi-res image Download (PPT)