Risk Factors For Uterine Rupture Research Articles

Trends, risk factors and pregnancy outcome in women with uterine rupture

This study aimed at determining trends, risk factors and pregnancy outcome in women with uterine rupture. A population-based study, comparing all singleton deliveries with and without uterine rupture between 1988 and 2009 was conducted. Statistical analysis was performed using a multiple logistic regression analysis. Uterine rupture occurred in 0.06% (n = 138) of all deliveries included in the study (n = 240,189); 59% in women with a previous cesarean delivery (CD). A gradual increase in the rate of uterine rupture from 1988 (0.01%) to 2009 (0.05%) was noted. Independent risk factors for uterine rupture in a multivariable analysis were: previous CD (OR = 7.4, 95% CI 5.2-10.6), preterm delivery (<37 weeks, OR = 2.5, 95% CI 1.5-4.1), malpresentation (OR = 3.0, 95% CI 1.9-4.5), parity (OR = 1.2, 95% CI 1.1-1.3 for each birth), and dystocia during the first and second stages of labor (OR = 4.1, 95% CI 2.3-7.4 and OR = 11.2, 95% CI 6.7-18.7, respectively). Uterine rupture led to significant maternal morbidity and perinatal mortality. In another multivariable analysis, with perinatal mortality as the outcome variable uterine rupture was noted as an independent risk factor for perinatal mortality (adjusted OR = 17.7; 95% CI 10.0-31.4, P < .01). Uterine rupture, associated with previous cesarean delivery, malpresentation, and labor dystocia, is an independent risk factor for perinatal mortality.

Risk factors for uterine rupture in the UK

BackgroundRecent reports of the risk of morbidity due to uterine rupture may have contributed to a decrease in the number of women attempting vaginal birth after caesarean section. The aims...

Severe Dysplasia and Spontaneous Uterus Rupture in Labour

The authors report a case of spontaneous uterine rupture in a patient with no risk factor. The break was initially silent and incomplete. Then, because of profuse bleeding was subjected to subtotal hysterectomy and is now in good health. Histological examination revealed severe dysplasia with necrosis of the coating of the esocervix . The authors conclude by stressing the importance of diagnostic assessment of the cervix in pregnancy is to prevent cervical cancer, to eliminate a rare risk factor for uterine rupture during labor.

The Role of Uterine Closure in the Risk of Uterine Rupture

A potentially modifiable risk factor for uterine rupture during labor is the uterine closure technique. There is no consensus at present on the most appropriate uterine closure, in part because previous studies examining the relationship between the technique used for closure and subsequent pregnancy outcome have been small and greatly underpowered. Two decades ago, the 2-layer technique was the most common and popular procedure for uterine closure. In the 1990s, single-layer closure gained popularity with obstetricians because of its shorter operative time and need for fewer hemostatic sutures, and presently this technique is commonly used. A retrospective study published in 2002 comparing the single- and 2-layer techniques reported that single-layer closure was associated with a 4-fold increased risk of subsequent uterine rupture in women undergoing a trial of labor after a previous cesarean. This multicenter, case–control study was designed to compare the independent contribution of a number of risk factors for uterine rupture in 2 groups of women who had a prior single low-transverse cesarean delivery; the study group was comprised of women who experienced complete uterine rupture during a trial of labor and the control group was comprised of women without uterine rupture during labor. Risk variables examined included maternal age, gestational age at delivery, prior vaginal delivery, maternal diabetes, interdelivery interval, induction of labor, cervical maturation, oxytocin or prostaglandin use, birth weight, prior method of uterine closure, and type of suture material. Univariable and multivariable conditional logistic regression analysis was conducted to estimate the effect of each variable on the risk of uterine rupture. The primary independent variable examined was type of closure (single or double layer or unknown). There were 96 cases of uterine rupture and 288 controls selected for analysis. Adverse outcomes occurred in 29% (28/96) of the neonates. The rate of single-layer closure was higher in the case group than in the controls (cases: 36%, 35/96, vs. controls: 20%, 58/288, P < 0.05). Multivariable analysis showed that single-layer closure (adjusted odds ratio [aOR], 2.69; 95% confidence interval [CI], 1.37–5.28) and birth weight more than 3500 gm (aOR, 2.03; 95% CI, 1.21–3.38) were associated with increased rates of uterine rupture, whereas previous vaginal birth was a protective factor (aOR, 0.47; 95% CI, 0.24–0.93, all 3 comparisons: P < 0.05). Single-layer closure was the only significant variable related to uterine rupture with adverse neonatal outcome (aOR, 2.89; 95% CI, 1.01–8.27). These findings indicate that prior single-layer closure has more than twice the risk of uterine rupture than double-layer closure, and suggest that the single-layer technique should be avoided in women who may choose future vaginal birth after cesarean delivery.

The Role of Uterine Closure in the Risk of Uterine Rupture

A potentially modifiable risk factor for uterine rupture during labor is the uterine closure technique. There is no consensus at present on the most appropriate uterine closure, in part because previous studies examining the relationship between the technique used for closure and subsequent pregnancy outcome have been small and greatly underpowered. Two decades ago, the 2-layer technique was the most common and popular procedure for uterine closure. In the 1990s, single-layer closure gained popularity with obstetricians because of its shorter operative time and need for fewer hemostatic sutures, and presently this technique is commonly used. A retrospective study published in 2002 comparing the single- and 2-layer techniques reported that single-layer closure was associated with a 4-fold increased risk of subsequent uterine rupture in women undergoing a trial of labor after a previous cesarean. This multicenter, case-control study was designed to compare the independent contribution of a number of risk factors for uterine rupture in 2 groups of women who had a prior single low-transverse cesarean delivery; the study group was comprised of women who experienced complete uterine rupture during a trial of labor and the control group was comprised of women without uterine rupture during labor. Risk variables examined included maternal age, gestational age at delivery, prior vaginal delivery, maternal diabetes, interdelivery interval, induction of labor, cervical maturation, oxytocin or prostaglandin use, birth weight, prior method of uterine closure, and type of suture material. Univariable and multivariable conditional logistic regression analysis was conducted to estimate the effect of each variable on the risk of uterine rupture. The primary independent variable examined was type of closure (single or double layer or unknown). There were 96 cases of uterine rupture and 288 controls selected for analysis. Adverse outcomes occurred in 29% (28/96) of the neonates. The rate of single-layer closure was higher in the case group than in the controls (cases: 36%, 35/96, vs. controls: 20%, 58/288, P < 0.05). Multivariable analysis showed that single-layer closure (adjusted odds ratio [aOR], 2.69; 95% confidence interval [CI], 1.37-5.28) and birth weight more than 3500 gm (aOR, 2.03; 95% CI, 1.21-3.38) were associated with increased rates of uterine rupture, whereas previous vaginal birth was a protective factor (aOR, 0.47; 95% CI, 0.24-0.93, all 3 comparisons: P < 0.05). Single-layer closure was the only significant variable related to uterine rupture with adverse neonatal outcome (aOR, 2.89; 95% CI, 1.01-8.27). These findings indicate that prior single-layer closure has more than twice the risk of uterine rupture than double-layer closure, and suggest that the single-layer technique should be avoided in women who may choose future vaginal birth after cesarean delivery.

The Role of Uterine Closure in the Risk of Uterine Rupture

To evaluate the effects of prior single-layer compared with double-layer closure on the risk of uterine rupture. A multicenter, case-control study was performed on women with a single, prior, low-transverse cesarean who experienced complete uterine rupture during a trial of labor. For each case, three women who underwent a trial of labor without uterine rupture after a prior low-transverse cesarean delivery were selected as control participants. Risk factors such as prior uterine closure, suture material, diabetes, prior vaginal delivery, labor induction, cervical ripening, birth weight, prostaglandin use, maternal age, gestational age, and interdelivery interval were compared between groups. Conditional logistic regression analyses were conducted. Ninety-six cases of uterine rupture, including 28 with adverse neonatal outcome, and 288 control participants were assessed. The rate of single-layer closure was 36% (35 of 96) in the case group and 20% (58 of 288) in the control group (P<.01). In multivariable analysis, single-layer closure (odds ratio [OR] 2.69; 95% confidence interval [CI] 1.37-5.28) and birth weight greater than 3,500 g (OR 2.03; 95% CI 1.21-3.38) were linked with increased rates of uterine rupture, whereas prior vaginal birth was a protective factor (OR 0.47; 95% CI 0.24-0.93). Single-layer closure was also related to uterine rupture associated with adverse neonatal outcome (OR 2.89; 95% CI 1.01-8.27). Prior single-layer closure carries more than twice the risk of uterine rupture compared with double-layer closure. Single-layer closure should be avoided in women who could contemplate future vaginal birth after cesarean delivery. II.

RUPTURED UTERUS

Objective: To analyze the risk factors for uterine rupture and to share the 5 years experience of ruptured uterus with other colleagues of the specialty. Study design: Case series descriptive study. Settings: Gynae /Obstetrics Unit -I Lady Willingdon Hospital Lahore. Study Duration: Five years i.e Ist May 2004 to 30th April 2009. Material and Methods: Obstetric patients who presented with ruptured uteri. Results: Results showed that risk factor for ruptured uteri include cesarean sections (61.11%), grand multiparty (16.6%), Instrumentaldeliveries (4.44%) and undetected perforation (1.11%). Conclusion: Ruptured uterus is a high risk category of patients. The patients with previous scar, grand multiparas, obstructed prolonged labour must be managed by proper trained personnel and in tertiary care centers in order to avoid the morbidity or mortality due to ruptured uterus.

Uterine rupture and subsequent pregnancy outcome – how safe is it? A 25-year study

Objectives. (a) To review the cases of ruptured uterus over the last 25 years and analyze the causative factors with a view to its prevention (b) To analyze subsequent pregnancy outcome with a view to its safety.Method. The case notes were reviewed for all patients with ruptured uterus over a period of 25 years from January 1982 to January 2007. Relevant dates relating to the characteristics of labor, delivery, maternal, perinatal, and subsequent pregnancy outcomes were assessed.Results. The incidence of ruptured uteri was calculated to be 0.03%. Total deliveries included in the study were 152,426. There were 46 cases of ruptured uteri and 44 were available for study. Twenty-two (52%) ruptured uteri occurred in patients with previous caesarean scars, of which 10 occurred in women with previous four or more caesarean sections. In 12 cases (27%), uterine rupture occurred due to oxytocin; PGE2 and oxytocin were used in 3 of these 12 cases. Two (4.5%) ruptures occurred due to non-removal of cervical cerclage during labor. Two (4.5%) primigravidae ruptured their uterus following road traffic accident, resulting in maternal and fetal deaths. Malpresentation in labor resulted in eight (18%) ruptures. Rupture occurred at the fundus in 10 cases and in the lower segment in the remaining 34. Fetal heart abnormalities were observed in all cases in which the uterus ruptured during labor. Abdominal hysterectomy was performed in 20 cases (45%) of which 13 were subtotal and 7 (10%) were total. Of the remaining 24 (55%) patients, 10 had suture repair and in addition 14 patients underwent hypogastric artery ligation. Later, 22/24 (92%) women became pregnant. Twenty (91%) were delivered by planned caesarean section. There were no maternal or fetal complications. The remaining two women had previous classical scar, undetected malpresentation, and sparse antenatal care. Their uteri ruptured spontaneously at 32 and 35 weeks at home. They died intra-operatively due to intractable hemorrhage along with their fetus.Conclusion. In the previous caesarean section, the indiscriminate use of oxytocin and malpresentation are the risk factors for uterine rupture. Child birth after uterine rupture is not to be recommended routinely. Most women with a previous uterine rupture with meticulous tertiary level antenatal care had a favorable outcome in subsequent pregnancies.

Risk factors for uterine rupture during a vaginal birth after one previous caesarean section: a case–control study

Objective To study risk factors for uterine rupture (UR) in women with one previous caesarean section (CS) undergoing a vaginal birth after CS (VBAC). Study design A nested case–control study was conducted. Baseline characteristics, general obstetric history, details of the previous CS, current delivery and maternal and neonatal outcome were analysed for 41 cases with a UR and 157 controls (no rupture). Data were extracted from 21 Dutch hospitals. Results Labour induction was more common in cases than in controls (51% vs. 25% respectively, P = 0.001), and in case of induction therapy especially the use of prostaglandins (PGE2) was more frequent in the case group (86% vs. 46%, P = 0.014 for cases and controls respectively). Patients with UR had a significantly lower Bishop score (median: 2.0 vs. 4.0, P = 0.005) and received more augmentation of labour compared to controls (36% vs. 18%, P = 0.010). In the multivariate analysis induction with PGE2 and oxytocin, induction with PGE2 alone, and augmentation of labour were independent variables affecting the occurrence of UR (respectively OR 13.0, CI 2.3–74.2; OR 4.6, CI 1.9–11.3 and OR 2.7, CI 1.2–6.3). Forty-four percent of the ruptures can be explained by induction of labour with prostaglandins ± oxytocin. Conclusion Having studied baseline characteristics, general obstetric history, details of the previous CS and of the current delivery, we show that no factors other than the use of PGE2 (±oxytocin) in response to a low Bishop score, and augmentation of labour with oxytocin are associated with an increased risk for UR in women undergoing VBAC after one previous CS.

Identifying Risk Factors for Uterine Rupture

Identifying Risk Factors for Uterine Rupture

Possible feto-maternal clinical risk of the Kristeller’s expression

AbstractThe aim of this clinical case study is evaluation of possible intrapartal complication of the uncritical Kristeller’s expression. In this retrospective clinical study, data on seven parturients with significant maternal or fetal intrapartum complications during the second labor stage and Kristeller expression, associated with the maneuver, were analyzed. Data was obtained from patient files: history of delivery delivery room protocol and neonatal reports from two tertiary maternal wards. There were five uterine ruptures that were treated by laparotomy and uterine sutures. Atypical rupture location on the uterine fundus occurred in one case, isthmus rupture in three cases, and rupture of the scar left after a previous cesarean section as a potential risk factor for uterine rupture in one case. Complex uterine cervicoisthmic rupture with incomplete colporrhexis occurred during the delivery of a macrosomic child at an outpatient ward. In one case, unilateral fracture of the tenth and eleventh ribs resolved spontaneously without complications. One case of peripartum trauma, possibly associated with extensive expression was observed in one neonates: cutaneous and subcutaneous hematoma on the back with traumatic unilateral adrenal hemorrhage. Both newborns were monitored, successfully treated, and discharged from the hospital free from complications. In conclusion, in the obstetrics as a high risk profession, a very critical approach should be exercised on choosing this maneuver, which should be reserved for the rare and strictly indicated cases, thereby strictly following the professional rules to avoid generally unnecessary and unpleasant litigation and forensic expertise.

Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population‐based study of successive pregnancies in Sweden

BJOG: An International Journal of Obstetrics & GynaecologyVolume 115, Issue 3 p. 415-415 Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population-based study of successive pregnancies in Sweden C Spencer, C Spencer Department of Obstetrics and Gynaecology, St John’s Hospital, Chelmsford, Essex, UKSearch for more papers by this authorP Robarts, P Robarts Department of Obstetrics and Gynaecology, St John’s Hospital, Chelmsford, Essex, UKSearch for more papers by this author C Spencer, C Spencer Department of Obstetrics and Gynaecology, St John’s Hospital, Chelmsford, Essex, UKSearch for more papers by this authorP Robarts, P Robarts Department of Obstetrics and Gynaecology, St John’s Hospital, Chelmsford, Essex, UKSearch for more papers by this author First published: 08 January 2008 https://doi.org/10.1111/j.1471-0528.2007.01617.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume115, Issue3February 2008Pages 415-415 RelatedInformation

Author response to: Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population‐based study of successive pregnancies in Sweden

Author response to: Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population‐based study of successive pregnancies in Sweden

Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population‐based study of successive pregnancies in Sweden

Uterine rupture is a rare but a catastrophic event. The aim of the present study was to explore the risk factors for uterine rupture and associated neonatal morbidity and mortality among a cohort of Swedish women attempting vaginal birth in their second delivery. Population-based cohort study. Sweden. A total of 300,200 Swedish women delivering two single consecutive births between 1983 and 2001. Swedish population-based registers were used to obtain information concerning demographics, pregnancy and birth characteristics, and neonatal outcomes. Logistic regression was used to analyse potential risk factors for uterine rupture and risk of neonatal mortality associated with uterine rupture. Odds ratios were used to estimate relative risks using 95% CI. Uterine rupture and neonatal mortality in the second pregnancy. Compared with women who delivered vaginally in their first birth, women who underwent a caesarean delivery were, during their second delivery, at increased risk of uterine rupture (adjusted OR 41.79; 95% CI 29.73-57.00). Induction of labour, high (> or = 4000 g) birthweight, postterm (> or = 42 weeks) births, high (> or = 35 years) maternal age, and short (< or = 164 cm) maternal stature were also associated with increased risk of uterine rupture. Uterine rupture was associated with a substantially increased risk in neonatal mortality (adjusted OR 65.62; 95% CI 32.60-132.08). The risk of uterine rupture in subsequent deliveries is not only markedly increased among women with a previous caesarean delivery but also influenced by induction of labour, birthweight, gestational age, and maternal characteristics.

Rupture of the scarred uterus

To assess the risk of uterine rupture of the scarred uterus according to mode of delivery in subsequent births recorded as spontaneous labour, labour induced by oxytocin, labour after ripening with prostaglandin E2, and planned cesarean section. Retrospective study of 2,128 births with a low transversal scar after a previous cesarean section. The study population was realised in a level III university hospital from 1995 to 2003. The association between mode of delivery and uterine rupture was studied in a multivariate logistic regression model, and adjusted for specific antenatal confounding factors. Over 9 years, we collected 22 cases (1%), including 11 asymptomatic ruptures in a population of 2,128 scarred uteri out of 28,248 deliveries. Uterine rupture occurred at a rate of 0.3 per 100 among women with repeated cesarean delivery without labour, 1 per 100 among women with spontaneous onset of labour, 1.4 per 100 among women with oxytocin-induced labour, and 2.2 per 100 among women with prostaglandin cervical ripening. Compared to women with a planned cesarean section, women with spontaneous onset of labour were more likely to have uterine rupture (OR: 4.0; 95% CI: 0.8-42.0). A greater relative risk was observed among women with oxytocin-induced labour (OR: 4.3; 95% CI: 0.3-60.0), and particularly those with prostaglandin-induced labour (OR: 8.7; 95% CI: 1.5-97.3, p=0.01). In women with a scarred uterus, prostaglandin E2 induction of labour is a risk factor for uterine rupture. The practice of a systematic cesarean section in cases with Bishop score<3, appropriate induction procedure, and rigorous monitoring of the labour, could make for a safer delivery.

Comment informer sur la voie d'accouchement une patiente ayant un antécédent de césarienne ?

A trial of labor after prior cesarean delivery is associated with a greater perinatal risk than is elective repeated cesarean delivery without labor, although absolute risks are low. Information and counselling aim to estimate specific risks and to balance these risks according to individual factors. Therefore, the physician has to answer two questions: (i) which would be the probability of successful vaginal delivery? (ii) which would be the risk of uterine rupture with a trial of labor? The risk factors for failure of trial of labor are: increased maternal age, obesity, and fetal macrosomia. The risk factors for uterine rupture are: increased maternal age, postpartum fever after the previous cesarean delivery, short interdelivery interval, history of at least two previous cesarean deliveries, and a history of classical incision. Conversely, other factors are of good prognosis: a prior vaginal delivery and, particularly, a prior VBAC (Vaginal Birth After Caesarean) are associated with a higher rate of successful trial of labor compared with patients with no prior vaginal delivery; ultrasonographic measurement of the lower uterine segment thickness>3.5 mm has an excellent negative predictive value for the risk of uterine defect. Finally, the wish for additional pregnancies following a cesarean section must be considered as an argument in favour of a trial of labor after accounting for the increasing risks correlated with repeated elective cesarean deliveries.

Previous preterm cesarean delivery: Identification of a new risk factor for uterine rupture in VBAC candidates

Objective. A major risk of trials of labor in patients with prior cesarean delivery is uterine rupture. We evaluated the question of whether a previous cesarean delivery at an early gestational age predisposes the patient to subsequent uterine rupture.Methods. This was a retrospective chart review of patients delivering at North Shore University Hospital with a trial of labor after previous cesarean delivery to ascertain all cases of uterine rupture. Patients who had had a previous cesarean delivery at our institution who did not suffer uterine rupture during a trial of labor served as controls.Results. Twenty-five patients suffered a uterine rupture. The incidence of prior preterm cesarean delivery (PPCD) in this group was 40%, compared to 10.9% of 691 laboring vaginal birth after cesarean (VBAC) patients without rupture (p < 0.001). Patients in the rupture group with a PPCD were less likely to have experienced labor in the index pregnancy and more likely to have had an interdelivery interval of less than two years.Conclusions. An undeveloped lower segment in the preterm uterus represents a risk for later rupture, even if the incision is transverse.

Maternal complications with vaginal birth after cesarean delivery: A multicenter study

This study was undertaken to determine incidence and risk factors for uterine rupture in women attempting vaginal birth after cesarean delivery (VBAC) in a wide range of hospital settings. We performed a case-control study nested within a cohort of women who have had a prior cesarean to determine the incidence and risk factors for uterine rupture in women attempting VBAC. The incidence rate of uterine rupture in those who attempt VBAC was 9.8 per 1000. A prior vaginal delivery was associated with a lower risk of uterine rupture (adjusted odds ratio [OR] = 0.40, 95% CI 0.20-0.81). Although prostaglandins alone were not associated with uterine rupture, sequential use of prostaglandin and pitocin was associated with uterine rupture (adjusted OR = 3.07, 95% CI 0.98-9.88). Women with a prior cesarean should be offered VBAC, and women with a prior cesarean and prior vaginal delivery should be encouraged to VBAC. Although other studies have suggested that prostaglandins should be avoided, we suggest that inductions requiring sequential agents be avoided.

How much pressure does a pressure dressing press? quantifying the effects of a pressure dressing on the post-cesarean section incision

EFFECTS OF A PRESSURE DRESSING ON THE POST-CESAREAN SECTION INCISION ANJALI KAIMAL, JAMES PHILLIP, JAMES GREENBERG, Brigham and Women’ s Hospital, Department of Obstetrics and Gynecology, Boston, Massachusetts, Brigham and Women’s Hospital, Department of Anesthesia, Boston, Massachusetts, Brigham and Women’s Hospital, Department of Obstetrics and Gynecology, Boston, Massachusetts OBJECTIVE: Application of a pressure dressing is intended to compress dead space and prevent hematoma and seroma formation, leading to decreased wound disruption, a complication that causes significant morbidity and cost. Theoretically, the pressure dressing improves hemostasis by preventing venous capillary blood loss and exudate. Conversely, pressure dressings may cause increased patient discomfort and their removal can be associated with skin trauma. Given the paucity of data supporting the benefit of a pressure dressing for an abdominal incision and the potentially deleterious effects, this pilot study seeks to determine the increase in pressure exerted by a pressure dressing after a primary cesarean section. STUDY DESIGN: After undergoing routine cesarean section via a Pfannenstiel skin incision, the wound pressures in five subjects were measured in three different states. Using a Stryker Intra-Compartmental Pressure Monitor System, subcutaneous tissue pressures were measured immediately after wound closure, after application of a simple Telfa dressing, and after application of a pressure dressing. A t-test was used to compare the measurements. RESULTS: Mean baseline pressure in the subcutaneous tissue in an undressed wound was 1.4 mmHg. After application of a Telfa dressing, the mean pressure was 1.8 mm Hg. After application of a pressure dressing, the mean pressure was 6.6 mm Hg. Application of a pressure dressing resulted in an average increase in pressure in the subcutaneous tissue of 4.8 mm Hg (P ! .005) as compared with a Telfa dressing alone. CONCLUSION: Application of a pressure dressing significantly increases the pressure in the subcutaneous tissue of a cesarean section incision. However, the increase in pressure demonstrated by this study may not be sufficient to overcome capillary venous pressure; therefore, the pressure dressing may not be able to decrease hematoma and seroma formation. Until there is data that a dressing can impact the pathophysiology of wound disruption, surgeons may want to reconsider the use of a pressure dressing in this setting. 221 LABOR INDUCTION AND AUGMENTATION: INDEPENDENT RISK FACTORS FOR UTERINE RUPTURE? GEORGE MACONES, DAVID STAMILIO, EMMANUELLE PARE, JEFFREY PEIPERT, ANTHONY SCISCIONE, HARISH SEHDEV, SARAH RATCLIFFE, MARY SAMMEL, University of Pennsylvania, Obstetrics and Gynecology, Philadelphia, Pennsylvania, Brown University, Obstetrics & Gynecology, Providence, Rhode Island, Drexel University, Obstetrics and Gynecology, Philadelphia, Pennsylvania, Pennsylvania Hospital, Obstetrics & Gynecology, Philadelphia, Pennsylvania, University of Pennsylvania, Biostatistics, Philadelphia, Pennsylvania OBJECTIVE: To determine whether induction and augmentation of labor with specific agents independently increases the risk of uterine rupture in women attempting VBAC. STUDY DESIGN: A case-control study, nested within a cohort study of 13,706 women who attempted VBAC at 17 participating institutions (community and tertiary), was performed. Cases of uterine rupture were compared to randomly selected controls for a variety of obstetrical, historical, and intrapartum factors. Information was collected from the inpatient medical record by trained research nurses. We used both bivariate and multivariate techniques to determine whether induction/augmentation and the use of specific agents increased the risk of uterine rupture. RESULTS: We identified 133 cases of uterine rupture (incidence = 0.98%) and compared them to 665 randomly selected controls. After adjustment for confounding factors, neither labor induction (adjusted OR= 1.0, 95% CI 0.42.3) nor labor augmentation (adjusted OR= 1.7, 95% CI 0.8-3.6) were independently associated with uterine rupture. The use of prostaglandins alone was not associated with an increased risk of uterine rupture (adjusted OR= 1.4, 95% CI 0.2-8.2). The use of sequential prostaglandin and pitocin was, however, associated with a 3 fold increase in the risk of rupture (adjusted OR= 3.1, 95% CI 1.0-9.8). CONCLUSION: In contrast to a prior report and ACOG’s recent opinion, prostaglandins alone do not appear to be associated with uterine rupture. The need for sequential prostaglandins and pitocin, signifying a more difficult induction, appears modestly associated with rupture.

Labor induction and augmentation: Independent risk factors for uterine rupture?

Labor induction and augmentation: Independent risk factors for uterine rupture?