Intrapartum Predictors of Uterine Rupture

ABSTRACT

This case-controlled study reviewed 26 cases of uterine rupture at an academic medical center. Controls were selected in a 2:1 design by reviewing the immediate successful vaginal birth after cesarean delivery (VBAC) before and after each case of uterine rupture. At less than 2 hours before delivery or acute uterine rupture, mild and severe variable decelerations, persistent abdominal pain, and hyperstimulation were more common in cases of uterine rupture as compared to controls and had statistically significant positive likelihood ratios (LR). Mild and severe variable fetal heart rate decelerations, especially in the presence of persistent abdominal pain, may predict uterine rupture in patients attempting VBAC.

KEYWORDS

VBAC - uterine rupture - mild variable decelerations - severe variable decelerations - persistent abdominal pain - hyperstimulation

REFERENCES

• 1 Phelan J P, Clark S L, Diaz F, Paul R H. Vaginal birth after cesarean.  Am J Obstet Gynecol. 1987;  157 1510-1515
• 2 Flamm B L, Newman L A, Thomas S J, Fallon D, Yoshida M M. Vaginal birth after cesarean delivery: results of a 5-year multicenter collaborative study.  Obstet Gynecol. 1990;  76 750-754
• 3 American College of Obstetricians and Gynecologists .Vaginal Birth after previous cesarean section. ACOG Practice Bulletin 54. Washington, DC; ACOG 2004
• 4 Phelan J P, Korst L M, Settles D K. Uterine activity patterns in uterine rupture: a case-control study.  Obstet Gynecol. 1998;  92 394-397
• 5 Ayres A W, Johnson T R, Hayashi R. Characteristics of fetal heart rate tracings prior to uterine rupture.  Int J Gynaecol Obstet. 2001;  74 235-240
• 6 Ridgeway J J, Weyrich D L, Benedetti T J. Fetal heart rate changes associated with uterine rupture.  Obstet Gynecol. 2004;  103 506-512
• 7 Yap O W, Kim E S, Laros Jr R K. Maternal and neonatal outcomes after uterine rupture in labor.  Am J Obstet Gynecol. 2001;  184 1576-1581
• 8 American College of Obstetricians and Gynecologists .Dystocia and augmentation of labor. ACOG Practice Bulletin 49. Washington, DC; ACOG 2003
• 9 Electronic fetal heart rate monitoring: research guidelines for interpretation. National Institute of Child Health and Human Development Research Planning Workshop.  Am J Obstet Gynecol. 1997;  177 1385-1390
• 10 Jones R O, Nagashima A W, Hartnett-Goodman M M, Goodlin R C. Rupture of low transverse cesarean scars during trial of labor.  Obstet Gynecol. 1991;  77 815-817
• 11 Menihan C A. Uterine rupture in women attempting a vaginal birth following prior cesarean birth.  J Perinatol. 1998;  18 440-443
• 12 Scott J R. Mandatory trial of labor after cesarean delivery: an alternative viewpoint.  Obstet Gynecol. 1991;  77 811-814
• 13 McMahon M J, Luther E R, Bowes Jr W A, Olshan A F. Comparison of a trial of labor with an elective second cesarean section.  N Engl J Med. 1996;  335 689-695
• 14 Mankuta D D, Leshno M M, Menasche M M, Brezis M M. Vaginal birth after cesarean section: trial of labor or repeat cesarean section? A decision analysis.  Am J Obstet Gynecol. 2003;  189 714-719
• 15 Grobman W A, Peaceman A M, Socol M L. Cost-effectiveness of elective cesarean delivery after one prior low transverse cesarean.  Obstet Gynecol. 2000;  95 745-751
• 16 Leung A S, Leung E K, Paul R H. Uterine rupture after previous cesarean delivery: maternal and fetal consequences.  Am J Obstet Gynecol. 1993;  169 945-950
• 17 Phelan J P. Uterine rupture.  Clin Obstet Gynecol. 1990;  33 432-437
• 18 Cowan R K, Kinch R A, Ellis B, Anderson R. Trial of labor following cesarean delivery.  Obstet Gynecol. 1994;  83 933-936
• 19 Kayani S I, Alfirevic Z. Uterine rupture after induction of labour in women with previous caesarean section.  BJOG. 2005;  112 451-455
• 20 Rodriguez M H, Masaki D I, Phelan J P, Diaz F G. Uterine rupture: are intrauterine pressure catheters useful in the diagnosis?.  Am J Obstet Gynecol. 1989;  161 666-669
• 21 Hamilton E F, Bujold E, McNamara H, Gauthier R, Platt R W. Dystocia among women with symptomatic uterine rupture.  Am J Obstet Gynecol. 2001;  184 620-624
• 22 Lydon-Rochelle M, Holt V L, Easterling T R, Martin D P. Risk of uterine rupture during labor among women with a prior cesarean delivery.  N Engl J Med. 2001;  345 3-8
• 23 Zelop C M, Shipp T D, Cohen A, Repke J T, Lieberman E. Trial of labor after 40 weeks’ gestation in women with prior cesarean.  Obstet Gynecol. 2001;  97 391-393