The Consequences of Previous Uterine Scar Dehiscence and Cesarean Delivery on Subsequent Births

Abstract

article i nfo Cesarean delivery Fetal complication Obstetric complication Risk factor Uterine rupture Uterine scar dehiscence Objective: To determine whether women with a previous uterine scar dehiscence are at increased risk of adverse perinatal outcomes in the following delivery. Methods: A retrospective cohort study was conducted of all subsequent singleton cesarean deliveries performed at the Soroka University Medical Center, Beer-Sheva, Israel, between January 1, 1988, and December 31, 2011. Clinical and demographic characteristics, maternal obstetric complications, and fetal complications were evaluated among women with or without a previous documented uterine scar dehiscence. Results: Of the 5635 pregnancies associated with at least two previous cesarean deliveries, 180 (3.2%) occurred among women with a previous uterine scar dehiscence. Women with this condition in a prior pregnancy were more likely than those without previous uterine scar dehiscence to experience subsequent preterm delivery (86 (47.8%) vs 1350 (24.7%); P b 0.001), low birth weight (47 (26.1%) vs861(15.8%);Pb 0.001),andperipartumhysterectomy(5(2.8%)vs20(0.4%);Pb 0.001).Nevertheless,previous uterine scar dehiscence did not increase the risk of uterine rupture, placenta accreta, or adverse perinatal out- comes, such as low Apgar scores at 5 minutes and perinatal mortality. Conclusion: Uterine scar dehiscence in a previouspregnancyisapotentialriskfactorforpretermdelivery,lowbirthweight,andperipartumhysterectomy