A 10‐Year Population‐Based Study of Uterine Rupture Shows Risks of VBAC to Mom and Baby are Low

by Birth Without Fear on November 5, 2011

Obstetrics and Gynecology released this 10 year population based study of uterine rupture in October 2002.

Objective

To review the incidence, associated factors, methods of diagnosis, and maternal and perinatal morbidity and mortality associated with uterine rupture in one Canadian province.

Methods

Using a perinatal database, all cases of uterine rupture in the province of Nova Scotia for the 10‐year period 1988–1997 were identified and the maternal and perinatal mortality and morbidity reviewed in detail.

Results

Over the 10 years, there were 114,933 deliveries with 39 cases of uterine rupture: 18 complete and 21 incomplete (dehiscence).

Thirty‐six women had a previous cesarean delivery: 33 low transverse, two classic, one low vertical.

Of the 114,933 deliveries, 11,585 (10%) were in women with a previous cesarean delivery.

Uterine rupture in those undergoing a trial for vaginal delivery (4516) was complete rupture in 2.4 per 1000 and dehiscence in 2.4 per 1000.

There were no maternal deaths, and maternal morbidity was low in patients with dehiscence. In comparison, 44% of those with complete uterine rupture received blood transfusion (odds ratio 7.60, 95% confidence interval 1.14, 82.14, P = .025).

Two perinatal deaths were attributable to complete uterine rupture, one after previous cesarean delivery. Compared with dehiscence, infants born after uterine rupture had significantly lower 5‐minute Apgar scores (P < .001) and asphyxia, needing ventilation for more than 1 minute (P < .01).

Conclusion

In 92% of cases, uterine rupture was associated with previous cesarean delivery. Uterine dehiscence was associated with minimal maternal and perinatal morbidity. In contrast, complete uterine rupture was associated with significantly more maternal blood transfusion and neonatal asphyxia.

Summary

Out of 114,933 deliveries, there were 39 total ruptures (.o34%), with 36 of them having a previous cesarean. Complete ruptures counted for 18 of those (.016% chance of complete uterine rupture). No mother deaths.

2 infant deaths (2 0f 114,933 deliveries is a 0.0017%). One of the deaths the mother had a previous cesarean, one had no previous cesarean.

Uterine scar dehiscence is different than complete uterine rupture. Dehiscence is the separation of a preexisting scar that doesn’t disrupt uterine serosa and that does not significantly bleed from its edges. In addition, the fetus, placenta, and umbilical cord must be contained within the uterine cavity, without a need for cesarean delivery due to fetal distress.

 

Thank you Candice Young for the beautiful picture.

Thank you Emily Cicora for sharing the article.

Percentages calculated here.

For more info on uterine rupture rates and cesarean risks.

Other resources: Uterine Rupture in Pregnancy

 

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