Uterine rupture during induced trial of labor among women with previous cesarean delivery

OBJECTIVE: This study was undertaken to compare the rates of uterine ruptur e during induced trials of labor after previous cesarean delivery with the rates during a spontaneous trial of labor. STUDY DESIGN: All deliveries between 1992 and 1998 among women with previou s cesarean delivery were evaluated. Rates of uterine rupture were determine d for spontaneous labor and different methods of induction. RESULTS: Of 2119 trials of labor, 575 (27%) were induced. The overall rate of uterine rupture was 0.71% (15/2119). The uterine rupture rate with induc ed trial of labor (8/575; 1.4%) was significantly higher than with a sponta neous trial of labor (7/1544; 0.45%; P = .0004). Uterine rupture rates asso ciated with different methods of induction were compared with the rate seen with spontaneous labor and were as follows: prostaglandin E-2 gel, 2.9% (5 /172; P = .004); intracervical Foley catheter, 0.76% (1/129; P = .47); and labor induction not requiring cervical ripening, 0.74% (2/274; P = .63). Th e uterine rupture rate associated with inductions other than with prostagla ndin E-2 was 0.74% (3/474; P = .38). The relative risk of uterine rupture w ith prostaglandin E-2 use versus spontaneous trial of labor was 6.41 (95% c onfidence interval, 2.06-19.98). CONCLUSION: Induction of labor was associated with an increased risk of ute rine rupture among women with a previous cesarean delivery, and this associ ation was highest when prostaglandin E-2 gel was used.