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

Abstract

An undeveloped lower segment in the preterm uterus represents a risk for later rupture, even if the incision is transverse.

Uterine rupture after previous caesarean section

“…27,28 We propose that mothers with these scars should be scheduled for elective caesarean section not later than 38 weeks. However, one should be aware that the risk of iatrogenic prematurity and respiratory problems would be increased in infants born by caesarean sections at earlier gestations; a balance between uterine rupture and prematurity risk should be assessed for each individual pregnancy.…”

Outcome of subsequent delivery after a previous early preterm cesarean section

“…Rochelson et al recently described an increased risk of uterine rupture after a previous preterm CS with transverse incision (before 37 weeks of gestation). He found 10 (11.8%) ruptures among 85 women undergoing a TOL after a preterm CS, compared with 15 (2.4%) ruptures among 631 women undergoing a TOL after a term CS [11]. The success rate after TOL was not described.…”

Current evidence in the management of previous caesarean section: clinical review

“…In the same study, perinatal outcomes were similar with pre-term TOL and ERCD [85]. A previous C-delivery at an early gestational age predisposes the patient to subsequent UR even if the incision is transverse [86]. The decision to attempt a TOL in the mid-trimester in women with a previous C-delivery should be based on the patient's individual circumstances, including the number of previous cesarean deliveries, placentation, gestational age and the woman's desire to preserve reproductive function (http:// www.acog.org/acog_districts/dist9/pb054.pdf).…”