Uterine rupture after previous low segment transverse cesarean is rarely catastrophic

Soltsman, Sofia; Perlitz, Yuri; Ami, Moshe Ben; Shlomo, Izhar Ben

doi:10.1080/14767058.2017.1297401

Cited by 13 publications

(19 citation statements)

References 4 publications

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“…Our results are partially consistent with the previous study that uterine rupture after previous low segment transverse caesarean is rarely catastrophic, and pregnant women with previous transverse CS having trial of vaginal birth have low risk of uterine rupture. [ 7 ] In our series, although 9.34% pregnant women with previous CS occurred LUS rupture in this study, there were no severe maternal and neonatal events. Three pregnant women with previous CS had spontaneous vaginal birth unexpectedly, and no uterine rupture occurred.…”

Section: Discussionmentioning

confidence: 46%

Ultrasonic assessment has high sensitivity for pregnant women with previous cesarean section occurring uterine dehiscence and rupture

Cui¹,

Wu²

2020

Medicine

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To investigate the diagnostic performance of ultrasound (US) for pregnant women with previous caesarean section (CS) occurring lower uterine segment (LUS) dehiscence and rupture. 107 pregnant women with previous CS and LUS thickness of 1.0 mm or less were recruited, the LUS and myometrium was measured, and US findings suggestive of uterine rupture were compared with findings at laparotomy. The included pregnant women were assigned into 2 groups, including 64 pregnant women had vaginal delivery at full-term and 43 pregnant women underwent repeat CS at preterm. US findings suggestive of uterine rupture and dehiscence occurred in 18 women and 89 women, respectively; ten of them developed uterine rupture, and the incidence of uterine rupture was 9.34% (10/107). The sensitivity, specificity, accuracy, positive, and negative predictive values of US for the evaluation of LUS dehiscence and rupture were 100.0%, 91.8%, 92.5%, 55.6%, and 100.0%, respectively. There was no severe maternal obstetric complication, 1 fetus died, and the other fetuses were born with a 5-minute Apgar score of 7 to 10. US has high sensitivity and specificity for pregnant women with previous CS occurring LUS dehiscence and rupture.

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Section: Discussionmentioning

confidence: 46%

Ultrasonic assessment has high sensitivity for pregnant women with previous cesarean section occurring uterine dehiscence and rupture

Cui¹,

Wu²

2020

Medicine

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“…Unfortunately, we have no such tool, and the SMFM calculator cannot be repurposed to this end. This is because few unsuccessful TOLACs result in uterine rupture, and few uterine ruptures result in permanent damage . Unfortunately, these rare outcomes are simply unpredictable for individual women and must be balanced against the immediate and long‐term risks of repeat cesareans.…”

Section: Predicting Disastermentioning

confidence: 99%

“…More recently, Scifres et al, using similar data, attempted to develop an algorithm that distinguishes women at risk for a composite outcome of uterine rupture, bladder injury, and bowel injury associated with TOLAC. Like Macones and Grobman, Scifres et al identified individual variables statistically associated with their composite. Despite having a large sample of women (13,706 women undergoing TOLAC and 300 composite morbidities), they could not reliably predict the composite outcome for individual women (the AUC was 0.65).…”

Section: Predicting Disastermentioning

confidence: 99%

Limitations of Vaginal Birth After Cesarean Success Prediction

Thornton¹

2018

J Midwife Womens Health

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The Society for Maternal-Fetal Medicine endorses an algorithm for estimating the probability of successful vaginal birth for women undergoing trial of labor after cesarean (TOLAC). The algorithm is available online in the form of an easy-to-use calculator. This calculator has significant limitations that are easily overlooked by women and providers alike. The calculator has much greater positive than negative predictive power, and it cannot predict unsuccessful TOLAC or uterine rupture. Furthermore, the calculator cannot predict rare catastrophes, such as unplanned hysterectomy, permanent injury, or death. Predictions are heavily influenced by race and ethnicity, which are social and not biological constructs. Relevant variables, such as provider attitudes and institutional differences, are not accounted for. Providers should be mindful and transparent about calculator limitations when counseling women, particularly Latina and African American women. It may be appropriate to use the calculator to inform but not restrict women's options.

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“…This finding suggests that the reduction in women undergoing TOLAC does not reflect improved selection of patients for VBAC [3,13]. Success rates for TOLAC range from 28 to 85% [3,[14][15][16] and are higher for women with a previous CS for nonrecurring indications, such as breech presentation, and for women with a previous vaginal birth [17][18][19][20]. Furthermore, TOLAC is supported by obstetrical best practice guidelines in numerous countries [7,9,11,21].…”

Section: Introductionmentioning

confidence: 99%

Factors obstetricians, family physicians and midwives consider when counselling women about a trial of labour after caesarean and planned repeat caesarean: a qualitative descriptive study

Landy

Sword

Kathnelson

et al. 2020

BMC Pregnancy Childbirth

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Background: Repeat caesarean sections (CSs) are major contributors to the high rate of CS in Canada and globally. Women's decisions to have a planned repeat CS (PRCS) or a trial of labour after CS (TOLAC) are influenced by their maternity care providers. This study explored factors maternity care providers consider when counselling pregnant women with a previous CS, eligible for a TOLAC, about delivery method. Methods: A qualitative descriptive design was implemented. Semi-structured, one-to-one in-depth telephone interviews were conducted with 39 maternity care providers in Ontario, Canada. Participants were recruited at 2 maternity care conferences and with the use of snowball sampling. Interviews were audio recorded and transcribed verbatim. Data were uploaded into the data management software, NVIVO 10.0 and analyzed using qualitative content analysis. Results: Participants consisted of 12 obstetricians, 13 family physicians and 14 midwives. Emergent themes, reflecting the factors maternity care providers considered when counselling on mode of delivery, were organized under the categories clinical/patient factors, health system factors and provider preferences. Maternity care providers considered clinical/patient factors, including women's choice … with conditions, their assessment of women's chances of a successful TOLAC, their perception of women's risk tolerance, women's preferred delivery method, and their perception of women's beliefs and attitudes about childbirth. Additionally, providers considered health system factors which included colleague support for TOLAC and time needed to mount an emergency CS. Finally, provider factors emerged as considerations when counselling. They included provider preference for PRCS or TOLAC, provider scope of practice, financial incentives and convenience related to PRCS, past experiences with TOLAC and PRCS and providers' perspectives on risk of TOLAC. Conclusion: The findings highlight the multiplicity of factors maternity care providers consider when counselling women. Effectively addressing clinical, health care system and personal factors that influence counselling may help decrease nonmedically indicated PRCS.

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Uterine rupture after previous low segment transverse cesarean is rarely catastrophic

Abstract: Cautious selection and close monitoring of candidates are the cornerstones of successful management of TOLAC. Readily available facilities for emergency cesarean delivery and concerted obstetrical team can save the mother and child from catastrophic complications.

Cited by 13 publications

References 4 publications

Ultrasonic assessment has high sensitivity for pregnant women with previous cesarean section occurring uterine dehiscence and rupture

Ultrasonic assessment has high sensitivity for pregnant women with previous cesarean section occurring uterine dehiscence and rupture

Limitations of Vaginal Birth After Cesarean Success Prediction

Factors obstetricians, family physicians and midwives consider when counselling women about a trial of labour after caesarean and planned repeat caesarean: a qualitative descriptive study

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