Risk of uterine rupture with a trial of labor in women with multiple and single prior cesarean delivery.

Content Provider	Semantic Scholar
Author	Landon, Mark B. Spong, Catherine Y. Thom, Elizabeth A. Hauth, John C. Bloom, Steven L. Varner, Michael W. Moawad, Atef H. Caritis, Steve N. Harper, Margaret Wapner, Ronald J. Sorokin, Yoram Miodovnik, Menachem Carpenter, Marshall W. J. Peaceman, Alan M. O'Sullivan, Michael Sibai, Baha M. Langer, Oded Thorp, John M. Ramin, Susan Marie Mercer, Brian M. Gabbe, Steven G.
Copyright Year	2006
Abstract	OBJECTIVE To determine whether the risk for uterine rupture is increased in women attempting vaginal birth after multiple cesarean deliveries. METHODS We conducted a prospective multicenter observational study of women with prior cesarean delivery undergoing trial of labor and elective repeat operation. Maternal and perinatal outcomes were compared among women attempting vaginal birth after multiple cesarean deliveries and those with a single prior cesarean delivery. We also compared outcomes for women with multiple prior cesarean deliveries undergoing trial of labor with those electing repeat cesarean delivery. RESULTS Uterine rupture occurred in 9 of 975 (0.9%) women with multiple prior cesarean compared with 115 of 16,915 (0.7%) women with a single prior operation (P = .37). Multivariable analysis confirmed that multiple prior cesarean delivery was not associated with an increased risk for uterine rupture. The rates of hysterectomy (0.6% versus 0.2%, P = .023) and transfusion (3.2% versus 1.6%, P < .001) were increased in women with multiple prior cesarean deliveries compared with women with a single prior cesarean delivery attempting trial of labor. Similarly, a composite of maternal morbidity was increased in women with multiple prior cesarean deliveries undergoing trial of labor compared with those having elective repeat cesarean delivery (odds ratio 1.41, 95% confidence interval 1.02-1.93). CONCLUSION A history of multiple cesarean deliveries is not associated with an increased rate of uterine rupture in women attempting vaginal birth compared with those with a single prior operation. Maternal morbidity is increased with trial of labor after multiple cesarean deliveries, compared with elective repeat cesarean delivery, but the absolute risk for complications is small. Vaginal birth after multiple cesarean deliveries should remain an option for eligible women. LEVEL OF EVIDENCE II-2.
Starting Page	12
Ending Page	20
Page Count	9
File Format	PDF HTM / HTML
Alternate Webpage(s)	http://unmfm.pbworks.com/w/file/fetch/81070154/TOLAC-multiple%20prior.pdf
PubMed reference number	16816050v1
Volume Number	108
Issue Number	1
Journal	Obstetrics and gynecology
Language	English
Access Restriction	Open
Subject Keyword	Cesarean section Confidence Intervals Fetal Membranes, Premature Rupture Hysterectomy Labor (Childbirth) Morbidity - disease rate Uterine Rupture Uterus Vagina
Content Type	Text
Resource Type	Article