Ab. Caughey et al., Rate of uterine rupture during a trial of labor in women with one or two prior cesarean deliveries, AM J OBST G, 181(4), 1999, pp. 872-876
OBJECTIVE: We sought to determine whether there is a difference in the rate
of symptomatic uterine rupture after a trial of labor in women who have ha
d 1 versus 2 prior cesarean deliveries.
STUDY DESIGN: The medical records of all women with a history of either 1 o
r 2 prior cesarean deliveries who elected to undergo a trial of labor durin
g a 12-year period (July 1984-June 1996) at the Brigham and Women's Hospita
l were reviewed. Rates of uterine rupture were compared for these 2 groups.
Potential confounding variables were controlled by using logistic regressi
on analyses.
RESULTS: Women with 1 prior cesarean delivery (n = 3757) had a rate of uter
ine rupture of 0.8%, whereas women with 2 prior cesarean deliveries (n = 13
4) had a rate of uterine rupture of 3.7% (P = .001). in a logistic regressi
on analysis that was controlled for maternal age, use of epidural analgesia
, oxytocin induction, oxytocin augmentation, the use of prostaglandin E-2 g
el, birth weight, gestational age, type of prior hysterotomy, year of trial
of labor. and prior Vaginal delivery, the odds ratio for uterine rupture i
n those patients with 2 prior cesarean deliveries was 4.8 (95% confidence i
nterval, 1.8-13.2)
CONCLUSIONS: Women with a history of 2 prior cesarean deliveries have an al
most 5-fold greater risk of uterine rupture than those with only 1 prior ce
sarean delivery.