Currently, there is debate about the safety of a trial of labor after a previous cesarean section due to the risk of uterine rupture (UR) and its potentially life-threatening consequences to mother and infant. This population-based study of all URs in Massachusetts from 1990 to 1998 initially identified suspect UR cases by hospital discharge code and used record abstraction to confirm actual cases. We identified 511 cases of UR among women with a singleton pregnancy who also had a previous Cesarean section. A logistical regression model was used to estimate the risk of various characteristics on having a severe UR. 119 mothers and/or infants (23.3%) had a poor outcome. The overall risk of a UR resulting in a poor outcome is less than 2 per 1,000. 72 women had a severe maternal outcome; one mother died, 31 had hysterectomies, 56 required blood transfusion, and 30 were admitted to ICU (40 women experienced more than one poor outcome). Among the infants, 77 infants had a poor outcome, 30 of whose mothers also had a poor outcome. Risk variables for severe UR examined include mother's obstetrical history, presence of placental abnormalities, and labor management including different induction methods, and the amount and number of hours of oxytocin infused. We were able to control for demographic characteristics, insurance type, hospital level, and maternal complications. These results will allow obstetrical providers to provide accurate information about the risk of uterine rupture so that their patients can make informed decisions before choosing a method delivery.
Learning Objectives: 1. Identify the problems of relying solely on hospital discharge data for studying uterine rupture. 2. Discuss the relative risks of obstetrical history characteristics and labor management on having a severe uterine rupture among women who have had a previous cesarean who rupture their uterus in a subsequent pregnancy.
Keywords: Maternal Morbidity, Pregnancy Outcomes
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.