Risk of uterine rupture in vaginal birth after cesarean: Systematic review

Abstract

ObjectiveTo assess the risk of uterine rupture (UR) in attempted vaginal birth after cesarean and to identify risk factors. MethodsSystematic review by consulting the following databases: PubMed (MEDLINE), Cochrane Library Plus, Embase, Nursing@Ovid, Cuidatge and Dialnet. The search was conducted between January and March 2015. MeSH descriptors used were: vaginal birth after cesarean; uterine rupture; labour induced and labour obstetric or trial of labour. There were no restrictions on date or language. The selection of articles was performed by 2 independent reviewers, standardised and unblinded. A critical review of the summary was conducted, and if was necessary, the full text was consulted. Prospective and retrospective documents were included. ResultsA total of 39 documents were included for their relevance and interest. Few clinical trials were found. The UR incidence on the results of the studies analysed ranged from 0.15 to 0.98% in spontaneous labour; 0.3–1.5% in stimulation and induction with oxytocin, and 0.68–2.3% in prostaglandin inductions. ConclusionsThe success of vaginal birth after cesarean is important and improves when conditions are optimal. However it is not without risks, the main one being UR. Induction of labour with oxytocin and/or prostaglandins appears as the main risk factor, while the spontaneous onset of labour and a prior vaginal birth are protective factors.