Risk factors for complete uterine rupture in patients with trial of labor after cesarean delivery

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica Pub Date : 2024-12-01 DOI:10.1111/aogs.15017

Hortense Didier-Mathon, Gilles Kayem, Thibault Thubert, Loîc Sentilhes, Charles Garabedian, Thomas Schmitz, Diane Korb, Edouard Lecarpentier, François Goffinet, Cyril Raiffort, Marie-Victoire Senat, Elie Azria, Aude Ricbourg, Alix Defline, Pierre Delorme

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Abstract

Introduction

Vaginal birth after cesarean delivery (VBAC) attempt is promoted to reduce cesarean-related morbidity, but it carries a risk of uterine rupture, posing significant maternal and neonatal risks. This study evaluated uterine rupture incidence and risk factors in a high VBAC attempt population.

Material and Methods

This was a 16-year retrospective multicenter case–control cohort study (2002–2018). Eleven French university hospitals participated. Women were included if they had a complete uterine rupture during a VBAC attempt. Two controls, defined as a VBAC attempt without uterine rupture, were randomly included for each case. We analyzed the risk factors of uterine rupture among the overall population and then among women who had labor induction and those who had spontaneous labor. Logistic regression was used to compute crude odds ratios (ORs) and 95% confidence intervals (CIs) for uterine rupture. Multivariable logistic regression was used to calculate adjusted ORs (aORs) and 95% CIs.

Results

Among 48 124 patients with a single prior cesarean section, 31668 (65.8%, 95% CI 65.3–66.2) had a VBAC attempt and 23 086 (72.9% 95% CI 72.4–73.4) had a successful vaginal delivery. The complete uterine rupture frequency was 0.63%. There were 199 cases of complete uterine rupture (0.63%, 95%CI 0.54–0.71) and 396 controls. Among the overall population, the odds of uterine rupture was inversely associated with prior vaginal delivery (adjusted odds ratio [aOR] 0.3, CI 95% 0.2–0.5) and positively with induction of labor (aOR 2.2, 95% CI 1.4–3.4). For women with spontaneous labor, the odds of uterine rupture was positively associated with a Bishop score<6 (aOR 1.8, 95%CI 1.0–3.0), arrest of cervical dilatation of at least 1 hr. (aOR, 1.8 95%CI 1.1–2.9) and oxytocin augmentation (aOR 2.2 95% CI 1.3–3.7). For women undergoing labor induction, no factors were significantly associated with uterine rupture.

Conclusions

Uterine rupture frequency was low among women with high rates of VBAC attempt and successful vaginal delivery and was reduced with previous vaginal birth and increased with induction of labor, regardless of the method used. It was associated with any dystocia during spontaneous labor and suspected macrosomia in induced women, which should be managed with caution.

Abstract Image

查看原文本刊更多论文

剖宫产后试产患者子宫完全破裂的危险因素。

剖宫产后阴道分娩（VBAC）的尝试被提倡以减少剖宫产相关的发病率，但它有子宫破裂的风险，对孕产妇和新生儿造成重大风险。本研究评估子宫破裂发生率和危险因素在高VBAC尝试人群。材料和方法：这是一项为期16年的回顾性多中心病例对照队列研究（2002-2018）。11家法国大学医院参与了研究。如果女性在VBAC尝试期间子宫完全破裂，则包括在内。两个对照组，定义为VBAC尝试没有子宫破裂，随机纳入每个病例。我们分析了所有人群中子宫破裂的危险因素以及引产和自然分娩的妇女。采用Logistic回归计算子宫破裂的粗优势比（ORs）和95%可信区间（CIs）。采用多变量logistic回归计算调整后的or （aORs）和95% ci。结果：48124例有过一次剖宫产史的患者中，31668例（65.8%,95% CI 65.3-66.2）尝试过VBAC， 23086例（72.9%,95% CI 72.4-73.4）成功阴道分娩。子宫完全破裂发生率为0.63%。子宫完全破裂199例（0.63%,95%CI 0.54 ~ 0.71），对照组396例。在总体人群中，子宫破裂的几率与既往阴道分娩呈负相关（调整优势比[aOR] 0.3, 95% CI 0.2-0.5），与引产呈正相关（aOR 2.2, 95% CI 1.4-3.4）。对于自然分娩的妇女，子宫破裂的几率与Bishop评分呈正相关。结论：在VBAC尝试率高和阴道分娩成功率高的妇女中，子宫破裂的频率较低，无论使用何种方法，阴道分娩的妇女子宫破裂频率降低，引产的妇女子宫破裂频率增加。它与自然分娩时的难产和引产妇女的疑似巨大儿有关，应谨慎处理。

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来源期刊

Acta Obstetricia et Gynecologica Scandinavica 医学-妇产科学

CiteScore

8.00

自引率

4.70%

发文量

180

审稿时长

3-6 weeks

期刊介绍： Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.