Citation
Sciscione, Anthony C.; Landon, Mark B.; Leveno, Kenneth J.; Spong, Catherine Y.; MacPherson, Cora; Varner, Michael W.; Rouse, Dwight J.; Moawad, Atef H.; Caritis, Steve N.; & Harper, Margaret A., et al. (2008). Previous Preterm Cesarean Delivery and Risk of Subsequent Uterine Rupture. Obstetrics & Gynecology, 111(3), 648-653.Abstract
OBJECTIVE: To determine if women with a history of a previous preterm cesarean delivery experienced an increased risk of subsequent uterine rupture compared with women who had a previous nonclassic term cesarean delivery.METHODS: A prospective observational study was performed in singleton gestations that had a previous nonclassic cesarean delivery from 1999 to 2002. Women with a history of a previous preterm cesarean delivery were compared with women who had a previous term cesarean delivery. Women who had both a preterm and term cesarean delivery were included in the preterm group.
RESULTS: A prior preterm cesarean delivery was significantly associated with an increased risk of subsequent uterine rupture (0.58% compared with 0.28%, P<.001). When women who had a subsequent elective cesarean delivery were removed (remaining n=26,454) women with a previous preterm cesarean delivery were still significantly more likely to sustain a uterine rupture (0.79% compared with 0.46%, P=.001). However, when only women who had a subsequent trial of labor were included, there was still an absolute increased risk of uterine rupture, but it was not statistically significant (1.00% compared with 0.68%, P=.081). In a multivariable analysis controlling for confounding variables (oxytocin use, two or more previous cesarean deliveries, a cesarean delivery within the past 2 years, and preterm delivery in the current pregnancy), patients with a previous preterm cesarean delivery remained at an increased risk of subsequent uterine rupture (P=.043, odds ratio 1.6, 95% confidence interval 1.01-2.50) compared with women with previous term cesarean delivery.
CONCLUSION: Women who have had a previous preterm cesarean delivery are at a minimally increased risk for uterine rupture in a subsequent pregnancy when compared with women who have had previous term cesarean deliveries.
LEVEL OF EVIDENCE: II.
URL
http://dx.doi.org/10.1097/AOG.0b013e318163cd3eReference Type
Journal ArticleYear Published
2008Journal Title
Obstetrics & GynecologyAuthor(s)
Sciscione, Anthony C.Landon, Mark B.
Leveno, Kenneth J.
Spong, Catherine Y.
MacPherson, Cora
Varner, Michael W.
Rouse, Dwight J.
Moawad, Atef H.
Caritis, Steve N.
Harper, Margaret A.
Sorokin, Yoram
Miodovnik, Menachem
Marshall, Carpenter
Peaceman, Alan M.
O'Sullivan, Mary Jo
Sibai, Baha M.
Langer, Oded
Thorp, John M., Jr.
Ramin, Susan M.
Mercer, Brian M., for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network