Risk Factors Associated with Uterine Rupture and Dehiscence: A Cross-Sectional Canadian Study

Figueiró-Filho, Ernesto Antônio; Mejia-Gomez, Javier; Farine, Dan

doi:10.1055/s-0041-1739461

Cited by 7 publications

(13 citation statements)

References 33 publications

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“…However, caution should be taken for mother with twin gestation requesting for VBAC because of uncertainty regarding the safety of planned VBAC in these group of women. Ford et al showed an increase (0.9%) scar rupture compared with the lower value in singleton with one previous lower segment scar [51,55]. In a recent multicenter retrospective cohort study with a sample size of 160 women with twin A in vertex position with a single previous lower segment caesarean section, Peled et al [56] stated that successful VBAC in selected twin was achieved in 86.3% while Levin et al [41] reported a success VBAC rate of 31.3% in women with twins who attempted VBAC with no prior vaginal delivery.…”

Section: Twin Gestationmentioning

confidence: 92%

“…It is appropriate to put in an intravenous canula and collect blood for a full blood count and blood group with the serum saved for access to immediate crossmatch if needed and oral intake should be restricted to clear fluid. The woman should be placed on continuous electronic fetal monitoring because an abnormal fetal rate is the most consistent finding in women who have uterine rupture [22,51]. A one-to-one midwifery support and continuous care is associated with improve birth outcome and this should be the norm in all facilities that allow women to attempt vaginal delivery with prior caesarean.…”

Section: Intra Partum Monitoring Of Vbacmentioning

confidence: 99%

“…It is recommended to perform another vaginal examination once the woman is in active phase, open a labour care guide and repeat vaginal examinations every 4 hours. It is important to note that uterine rupture, which is the disruption of the uterine muscle, with or without the serosa [52] can occur at any stage of labour and they are no reliable clinical markers for early detection [22,51,52]. A prolonged and profound bradycardia correlates with more than 80% of uterine rupture.…”

Section: Intra Partum Monitoring Of Vbacmentioning

confidence: 99%

“…The third stage of labour should be managed based on local guideline for active management of the 3rd stage of labour. There are no contraindications to use of analgesia both systemic and regional in women during TOLAC [51].…”

Section: Intra Partum Monitoring Of Vbacmentioning

confidence: 99%

“…However, there are inadequate and underpowered studies from randomised controlled trials concerning these clinical dilemmas. Therefore, when considering augmentation or induction of labour in patients with one prior lower segment caesarean section, the risks and benefits should be borne in mind by the clinician and discussed with the woman [51]. In an observational metanalysis of 14 studies [42] and a total of 48,457 women that underwent TOLAC, the rate of uterine rupture after induction was estimated to be about 2.2% which is which is a more than 4-fold increase in rate of uterine rupture when compared to an unstimulated uterus.…”

Section: Augmentation and Induction Of Labourmentioning

confidence: 99%

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Vaginal Birth after Caesarean (VBAC)

Nggada¹

2023

New Aspects in Cesarean Sections

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The rising rate of caesarean section has implications in the reproductive performance of a woman and increases the likelihood of complications during repeat operations, whether they are planned or performed on an emergency basis. A successful vaginal delivery after caesarean is associated with increased maternal satisfaction, reduced caesarean section rate, and appears to be cost effective. There is a need for careful selection of women that are willing to attempt vaginal birth after caesarean with a clear set of local protocols to increase overall success rate, reduce litigation and improve neonatal outcome. The benefits and risks of planned vaginal birth after caesarean and elective repeat caesarean section should be discussed in detail with the woman during antenatal care and reemphasized at admission to the labour ward. A decision to embark on VBAC should be free from coercion with full informed consent as the bedrock for such a decision. Facilities offering vaginal birth in women with prior caesarean delivery should be equipped with 24-hour standby emergency caesarean section capability. The intrapartum care should be carefully tailored to meet the woman’s need with support from the health care team. Every obstetrics unit should debrief women after delivery irrespective of the outcome and should conduct regular audits to improve the care of women with previous caesarean sections.

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Section: Twin Gestationmentioning

confidence: 92%

Section: Intra Partum Monitoring Of Vbacmentioning

confidence: 99%

Section: Intra Partum Monitoring Of Vbacmentioning

confidence: 99%

Section: Intra Partum Monitoring Of Vbacmentioning

confidence: 99%

Section: Augmentation and Induction Of Labourmentioning

confidence: 99%

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Vaginal Birth after Caesarean (VBAC)

Nggada¹

2023

New Aspects in Cesarean Sections

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Unintended lower‐segment hysterotomy extension at cesarean delivery and the risk for uterine rupture during a subsequent trial of labor

Peled

Ashwal‏

Rotem

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo evaluate the association between unintended uterine extension in cesarean delivery and uterine scar disruption (rupture or dehiscence) at the subsequent trial of labor after cesarean delivery (TOLAC).MethodsThis is a multicenter retrospective cohort study (2005–2021). Parturients with a singleton pregnancy who had unintended lower‐segment uterine extension during the primary cesarean delivery (excluding T and J vertical extensions) were compared with patients who did not have an unintended uterine extension. We assessed the subsequent uterine scar disruption rate following the subsequent TOLAC and the rate of adverse maternal outcome.ResultsDuring the study period, 7199 patients underwent a trial of labor and were eligible for the study, of whom 1245 (17.3%) had a previous unintended uterine extension and 5954 (82.7%) did not. In univariate analysis, previous unintended uterine extension during the primary cesarean delivery was not significantly associated with uterine scar rupture in the following subsequent TOLAC. Nevertheless, it was associated with uterine scar dehiscence, higher rates of TOLAC failure, and a composite adverse maternal outcome. In multivariate analyses, only the association between previous unintended uterine extension and higher rates of TOLAC failure was confirmed.ConclusionA history of unintended lower‐segment uterine extension is not associated with an increased risk for uterine scar disruption following subsequent TOLAC.

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