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Am J Perinatol 2007; 24(5): 317-321
DOI: 10.1055/s-2007-981433
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Intrapartum Predictors of Uterine Rupture

Elizabeth Craver Pryor1 , Heather L. Mertz1 , Brittian W. Beaver1 , Gretchen Koontz1 , Anibal Martinez-Borges1 , Jennifer G. Smith1 , David Merrill1
  • 1Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Publication History

Publication Date:
21 May 2007 (online)

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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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 3 American College of Obstetricians and Gynecologists .Vaginal Birth after previous cesarean section. ACOG Practice Bulletin 54. Washington, DC; ACOG 2004
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 6 Ridgeway J J, Weyrich D L, Benedetti T J. Fetal heart rate changes associated with uterine rupture.  Obstet Gynecol. 2004;  103 506-512
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 8 American College of Obstetricians and Gynecologists .Dystocia and augmentation of labor. ACOG Practice Bulletin 49. Washington, DC; ACOG 2003
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 11 Menihan C A. Uterine rupture in women attempting a vaginal birth following prior cesarean birth.  J Perinatol. 1998;  18 440-443
    PubMedGoogle Scholar
  • 12 Scott J R. Mandatory trial of labor after cesarean delivery: an alternative viewpoint.  Obstet Gynecol. 1991;  77 811-814
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 17 Phelan J P. Uterine rupture.  Clin Obstet Gynecol. 1990;  33 432-437
    PubMedGoogle Scholar
  • 18 Cowan R K, Kinch R A, Ellis B, Anderson R. Trial of labor following cesarean delivery.  Obstet Gynecol. 1994;  83 933-936
    PubMedGoogle Scholar
  • 19 Kayani S I, Alfirevic Z. Uterine rupture after induction of labour in women with previous caesarean section.  BJOG. 2005;  112 451-455
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar

Heather L MertzM.D. 

Wake Forest University School of Medicine, Department of Obstetrics & Gynecology

Medical Center Boulevard, Winston-Salem, NC 27157

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