Factors predisposing to perinatal death related to uterine rupture during attempted vaginal birth after caesarean section: retrospective cohort study.

BMJ. 2004 Aug 14;329(7462):375. Epub 2004 Jul 19.
  
Factors predisposing to perinatal death related to uterine rupture during 
attempted vaginal birth after caesarean section: retrospective cohort study.

Smith GC, Pell JP, Pasupathy D, Dobbie R.

Department of Obstetrics and Gynaecology, Cambridge University, Cambridge 
CB2 2QQ.
gcss2@cam.ac.uk

OBJECTIVE: To determine the factors associated with an increased risk of perinatal 
death related to uterine rupture during attempted vaginal birth after caesarean 
section. 

DESIGN: Population based retrospective cohort study. 

SETTING: Data from the linked Scottish Morbidity Record and Stillbirth and 
Infant Death Survey of births in Scotland, 1985-98. 

PARTICIPANTS: All women with one previous caesarean delivery who gave birth to a 
singleton infant at term by a means other than planned repeat caesarean section 
(n = 35 854). 

MAIN OUTCOME MEASURES: All intrapartum uterine rupture and uterine rupture 
resulting in perinatal death (that is, death of the fetus or neonate). 

RESULTS: The overall proportion of vaginal births was 74.2% and of uterine 
rupture was 0.35%. The risk of intrapartum uterine rupture was higher among women 
who had not previously given birth vaginally (adjusted odds ratio 2.5, 95% 
confidence interval 1.6 to 3.9, P < 0.001) and those whose labour was induced 
with prostaglandin (2.9, 2.0 to 4.3, P < 0.001). Both factors were also associated 
with an increased risk of perinatal death due to uterine rupture. Delivery in a 
hospital with < 3000 births a year did not increase the overall risk of uterine 
rupture (1.1, 0.8 to 1.5, P = 0.67). However, the risk of perinatal death due to 
uterine rupture was significantly higher in hospitals with < 3000 births a year 
(one per 1300 births) than in hospitals with >or= 3000 births a year (one per 
4700; 3.4, 1.0 to 14.3, P = 0.04). 

CONCLUSION: Women who have not previously given birth vaginally and those whose 
labour is induced with prostaglandin are at increased risk of uterine rupture 
when attempting vaginal birth after caesarean section. The risk of consequent 
death of the infant is higher in units with lower annual numbers of births.

PMID: 15262772 [PubMed - in process]

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