Risk factors for complete uterine rupture in patients with trial of labor after cesarean delivery
Abstract Introduction Vaginal birth after cesarean delivery (VBAC) attempt is promoted to reduce cesarean‐related morbidity, but it carries a risk of uterine rupture, posing significant maternal and neonatal risks. This study evaluated uterine rupture incidence and risk factors in a high VBAC attemp...
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Wiley
2025-02-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.15017 |
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| author | Hortense Didier‐Mathon Gilles Kayem Thibault Thubert Loîc Sentilhes Charles Garabedian Thomas Schmitz Diane Korb Edouard Lecarpentier François Goffinet Cyril Raiffort Marie‐Victoire Senat Elie Azria Aude Ricbourg Alix Defline Pierre Delorme |
| author_facet | Hortense Didier‐Mathon Gilles Kayem Thibault Thubert Loîc Sentilhes Charles Garabedian Thomas Schmitz Diane Korb Edouard Lecarpentier François Goffinet Cyril Raiffort Marie‐Victoire Senat Elie Azria Aude Ricbourg Alix Defline Pierre Delorme |
| author_sort | Hortense Didier‐Mathon |
| collection | DOAJ |
| description | Abstract Introduction Vaginal birth after cesarean delivery (VBAC) attempt is promoted to reduce cesarean‐related morbidity, but it carries a risk of uterine rupture, posing significant maternal and neonatal risks. This study evaluated uterine rupture incidence and risk factors in a high VBAC attempt population. Material and Methods This was a 16‐year retrospective multicenter case–control cohort study (2002–2018). Eleven French university hospitals participated. Women were included if they had a complete uterine rupture during a VBAC attempt. Two controls, defined as a VBAC attempt without uterine rupture, were randomly included for each case. We analyzed the risk factors of uterine rupture among the overall population and then among women who had labor induction and those who had spontaneous labor. Logistic regression was used to compute crude odds ratios (ORs) and 95% confidence intervals (CIs) for uterine rupture. Multivariable logistic regression was used to calculate adjusted ORs (aORs) and 95% CIs. Results Among 48 124 patients with a single prior cesarean section, 31668 (65.8%, 95% CI 65.3–66.2) had a VBAC attempt and 23 086 (72.9% 95% CI 72.4–73.4) had a successful vaginal delivery. The complete uterine rupture frequency was 0.63%. There were 199 cases of complete uterine rupture (0.63%, 95%CI 0.54–0.71) and 396 controls. Among the overall population, the odds of uterine rupture was inversely associated with prior vaginal delivery (adjusted odds ratio [aOR] 0.3, CI 95% 0.2–0.5) and positively with induction of labor (aOR 2.2, 95% CI 1.4–3.4). For women with spontaneous labor, the odds of uterine rupture was positively associated with a Bishop score<6 (aOR 1.8, 95%CI 1.0–3.0), arrest of cervical dilatation of at least 1 hr. (aOR, 1.8 95%CI 1.1–2.9) and oxytocin augmentation (aOR 2.2 95% CI 1.3–3.7). For women undergoing labor induction, no factors were significantly associated with uterine rupture. Conclusions Uterine rupture frequency was low among women with high rates of VBAC attempt and successful vaginal delivery and was reduced with previous vaginal birth and increased with induction of labor, regardless of the method used. It was associated with any dystocia during spontaneous labor and suspected macrosomia in induced women, which should be managed with caution. |
| format | Article |
| id | doaj-art-cae0a62b3fef4cb7a0c7b73381cc9cbb |
| institution | Kabale University |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
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| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-cae0a62b3fef4cb7a0c7b73381cc9cbb2025-08-20T03:31:01ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122025-02-01104238038810.1111/aogs.15017Risk factors for complete uterine rupture in patients with trial of labor after cesarean deliveryHortense Didier‐Mathon0Gilles Kayem1Thibault Thubert2Loîc Sentilhes3Charles Garabedian4Thomas Schmitz5Diane Korb6Edouard Lecarpentier7François Goffinet8Cyril Raiffort9Marie‐Victoire Senat10Elie Azria11Aude Ricbourg12Alix Defline13Pierre Delorme14Department of Obstetrics and Gynecology Bichat Hospital AP‐HP Paris FranceDepartment of Gynecology and Obstetrics Sorbonne Université, AP‐HP, Trousseau Hospital Paris FranceDepartment of Obstetrics and Gynecology Nantes Hospital Nantes FranceDepartment of Obstetrics and Gynecology Bordeaux University Hospital Bordeaux FranceDepartment of Obstetrics and Gynecology CHU Lille, Univ. Lille, ULR2694 Lille FranceDepartment of Obstetrics and Gynecology Université Paris Cité, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Robert Debré Hospital, AP‐HP Paris FranceDepartment of Obstetrics and Gynecology Université Paris Cité, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Robert Debré Hospital, AP‐HP Paris FranceDepartment of Obstetrics, Gynecology and Reproductive Medicine, Centre Hospitalier Inter‐Communal de Créteil Creteil FranceDepartment of Obstetrics and Gynecology Port‐Royal Hospital, AP‐HP Paris FranceDepartment of Obstetrics and Gynecology Louis‐Mourier Hospitlal, Colombes, AP‐HP Colombes FranceDepartment of Obstetrics and Gynecology Bicêtre Hospital, AP‐HP Le Kremlin‐Bicêtre FranceDepartment of Obstetrics and Gynecology Saint‐Joseph Hospital Paris FranceDepartment of Obstetrics and Gynecology Lariboisiere Hospital, AP‐HP Paris FranceDepartment of Obstetrics and Gynecology Institut Mutaliste Montsouris Paris FranceDepartment of Gynecology and Obstetrics Sorbonne Université, AP‐HP, Trousseau Hospital Paris FranceAbstract Introduction Vaginal birth after cesarean delivery (VBAC) attempt is promoted to reduce cesarean‐related morbidity, but it carries a risk of uterine rupture, posing significant maternal and neonatal risks. This study evaluated uterine rupture incidence and risk factors in a high VBAC attempt population. Material and Methods This was a 16‐year retrospective multicenter case–control cohort study (2002–2018). Eleven French university hospitals participated. Women were included if they had a complete uterine rupture during a VBAC attempt. Two controls, defined as a VBAC attempt without uterine rupture, were randomly included for each case. We analyzed the risk factors of uterine rupture among the overall population and then among women who had labor induction and those who had spontaneous labor. Logistic regression was used to compute crude odds ratios (ORs) and 95% confidence intervals (CIs) for uterine rupture. Multivariable logistic regression was used to calculate adjusted ORs (aORs) and 95% CIs. Results Among 48 124 patients with a single prior cesarean section, 31668 (65.8%, 95% CI 65.3–66.2) had a VBAC attempt and 23 086 (72.9% 95% CI 72.4–73.4) had a successful vaginal delivery. The complete uterine rupture frequency was 0.63%. There were 199 cases of complete uterine rupture (0.63%, 95%CI 0.54–0.71) and 396 controls. Among the overall population, the odds of uterine rupture was inversely associated with prior vaginal delivery (adjusted odds ratio [aOR] 0.3, CI 95% 0.2–0.5) and positively with induction of labor (aOR 2.2, 95% CI 1.4–3.4). For women with spontaneous labor, the odds of uterine rupture was positively associated with a Bishop score<6 (aOR 1.8, 95%CI 1.0–3.0), arrest of cervical dilatation of at least 1 hr. (aOR, 1.8 95%CI 1.1–2.9) and oxytocin augmentation (aOR 2.2 95% CI 1.3–3.7). For women undergoing labor induction, no factors were significantly associated with uterine rupture. Conclusions Uterine rupture frequency was low among women with high rates of VBAC attempt and successful vaginal delivery and was reduced with previous vaginal birth and increased with induction of labor, regardless of the method used. It was associated with any dystocia during spontaneous labor and suspected macrosomia in induced women, which should be managed with caution.https://doi.org/10.1111/aogs.15017cesarean sectionobstetric labor complicationsuterine rupturevaginal birth after cesarean delivery (VBAC) attempt |
| spellingShingle | Hortense Didier‐Mathon Gilles Kayem Thibault Thubert Loîc Sentilhes Charles Garabedian Thomas Schmitz Diane Korb Edouard Lecarpentier François Goffinet Cyril Raiffort Marie‐Victoire Senat Elie Azria Aude Ricbourg Alix Defline Pierre Delorme Risk factors for complete uterine rupture in patients with trial of labor after cesarean delivery Acta Obstetricia et Gynecologica Scandinavica cesarean section obstetric labor complications uterine rupture vaginal birth after cesarean delivery (VBAC) attempt |
| title | Risk factors for complete uterine rupture in patients with trial of labor after cesarean delivery |
| title_full | Risk factors for complete uterine rupture in patients with trial of labor after cesarean delivery |
| title_fullStr | Risk factors for complete uterine rupture in patients with trial of labor after cesarean delivery |
| title_full_unstemmed | Risk factors for complete uterine rupture in patients with trial of labor after cesarean delivery |
| title_short | Risk factors for complete uterine rupture in patients with trial of labor after cesarean delivery |
| title_sort | risk factors for complete uterine rupture in patients with trial of labor after cesarean delivery |
| topic | cesarean section obstetric labor complications uterine rupture vaginal birth after cesarean delivery (VBAC) attempt |
| url | https://doi.org/10.1111/aogs.15017 |
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