Prior Cesarean Delivery Treatment

Prior Cesarean Delivery Treatment

Introduction: Every year in the United States, nearly 60% of women with a prior cesarean delivery who become pregnant again attempt labor. Concerns have been expressed that a trial of labor may increase the risk of uterine rupture. State-wide linked birth-certificate and hospital-discharge data were used to evaluate the risk of uterine rupture associated with spontaneous onset of labor, induction of labor without prostaglandins, induction of labor with prostaglandins, and repeated cesarean delivery without labor among women with 1 prior cesarean delivery.

 Methods: A population based, retrospective analysis was performed with the use of data from all primiparous women who gave birth to live singletons by cesarean section in civilian hospitals in Washington state between 1987 and 1996 and who delivered a second singleton child during the same time period. A total of 20,095 women were assessed for the risk of uterine rupture for deliveries with spontaneous onset of labor, those with labor induced by prostaglandins, and those in which labor was inducted by other means. These 3 groups of deliveries were compared in women who had repeated cesarean delivery without labor.

Results: The rate of uterine rupture was 1.6 cases per 1000 among women with repeated cesarean delivery without delivery (11 women), 5.2 cases per 1000 among women with spontaneous onset of labor (56 women), 7.7 cases per 1000 among women whose labor was induced without prostaglandins (15 women), and 24.5 cases per 1000 among women with prostaglandin-induced labor (9 women).Compared with the risk of uterine rupture among women with repeated cesarean delivery without labor, this occurrence was more likely among women with spontaneous onset of labor (relative risk [RR], 3.3; 95% confidence interval [CI], 2.4-9.7), and induction with prostaglandins (RR, 15.6; 95% CI, 8.1-30.0).

Conclusion: For women with 1 prior cesarean delivery, the risk of uterine rupture is higher among those whose delivery is induced than those with repeated delivery without labor. The highest risk is among women whose labor is induced with prostaglandins.