Labor prior to cesarean may decrease future uterine rupture risk
Source: Obstetrics and Gynecology 2008; 112: 1061-66
Estimating the effect of labor onset before cesarean delivery on the risk for
uterine rupture in a trial of labor for subsequent delivery.
MedWire News:
A primary cesarean delivery preceded by spontaneous onset of labor is
associated with a decreased risk for uterine rupture for women attempting vaginal birth after cesarean (VBAC) at their next delivery, a study suggests.
Charles Algert, from the Royal North Shore Hospital in Sydney,
Australia, and colleagues analyzed 10,160 primary cesarean deliveries
followed by subsequent births, for the effects of a trial of labor and
primary cesarean delivery on the risk for uterine rupture in women
attempting VBAC.
Their study found that 39 (0.38 percent) of the 10,160 women who
attempted VBAC had a uterine rupture. Women with a history of either
spontaneous labor or vaginal birth had one rupture for every 460
deliveries, compared with one rupture in 95 among women without this
history who also required induction for their trial of labor.
Algert et al also found that combined risk for uterine rupture during VBAC was increased 2.61 fold if the primary cesarean delivery was preceded by either induction or no labor, compared with spontaneous labor. This risk remained after adjustment for age, payment status, and onset of labor at trial of labor and at primary cesarean delivery. Furthermore, women induced for their trial of labor had a 4.24-fold increased relative risk for uterine rupture, the authors note.
“Our results can inform protocols for treating women who intend a first trial of labor,” concludes the team.
Posted: 24 November 2008
© 2008 Current Medicine Group Ltd, a part of Springer Science+Business Media
Date:
Nov 26 2008
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What is uterine
What is uterine rupture?
Put simply, the uterus can be compared to an egg: it consists of a membrane (shell) surrounding a muscle (white), the baby’s amniotic fluid is within (the location of the yellow ).
During childbirth, the lower end of the uterus gets. It is quite possible that the uterine muscle deviates uterus was then closed by the membrane: it is a dehiscence of the lower segment of the uterus. This poses no problem, except that the work can be slowed, leading to a caesarean section to work stoppage. But more often, birth normally happens, and possible dehiscence is not detected (it is detectable in practicing a uterus, a gesture that does not happen without good reason, eg cases of abnormal bleeding). It is also possible, although extremely rare, as the membranes rupture too.
In the case of uterine scar, or the scars that hinder previous muscle stretch: the scar tissue, very solid, does not stretch, so the surrounding tissues to stretch more. They are therefore subject to greater tension.
If the muscle does not stretch and tear, but the uterus is closed by the membrane, we refer to dehiscence of the scar, the disunity of the scar, pre-rupture or incomplete fracture (these terms are used interchangeably).
If the muscle membrane and tear, we speak of complete uterine rupture. It should be noted that in general, a complete rupture does not occur suddenly, when everything was going well until now: the more often we will first noticed symptoms of disunity (fetal, slowdown of work, pain) .
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