Rupture of a cesarean-scarred uterus: A community hospital experience

Concerns that a scarred uterus may rupture during labor have contributed to increased cesarean rates. A previous cesarean has become one of the most c ommon indications for abdominal birth. More women must deliver vaginally af ter cesarean if we are to reduce cesarean rates. This study evaluates the e ffect of decreasing cesarean rates and increased vaginal birth after cesare an (VBAC) rates on the incidence of uterine rupture in a community hospital . We studied data For women who delivered at our obstetrical unit from 1988 t hrough 1997. During 1994 our department adopted strategies to reduce cesare an rates. Data from women who delivered from 1988 through 1993 (period A, b efore the policy change) were compared with data for those who delivered fr om 1994 through 1997 (period B, after the policy change) and evaluated by c hi-square analysis. p < 0.05 was considered significant. The total cesarean Fate decreased from 24.3% (period A) to 17.9% (period B) (p < 0.0001), whereas the primary cesarean rate decreased from 14.9% to 10 .3% (p < 0.0001), and the repeat rate decreased from 9.4% to 7.6% (p < 0.00 01). the VBAC rate increased from 13.0 to 28.6 (p < 0.0001), whereas the in cidence of: uterine rupture did not change. During the study period, the ce sarean rate decreased white the VBAC rate safely increased. The incidence o f uterine rupture remained unchanged.