FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Volume 345:3-8 July 5, 2001 Number 1 Next

	Full Text PDF Editorial by Greene, M. F. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Each year in the United States, approximately 60 percent of women with a prior cesarean delivery who become pregnant again attempt labor. Concern persists that a trial of labor may increase the risk of uterine rupture, an uncommon but serious obstetrical complication.

Methods We conducted a population-based, retrospective cohort analysis using data from all primiparous women who gave birth to live singleton infants by cesarean section in civilian hospitals in Washington State from 1987 through 1996 and who delivered a second singleton child during the same period (a total of 20,095 women). We assessed the risk of uterine rupture for deliveries with spontaneous onset of labor, those with labor induced by prostaglandins, and those in which labor was induced by other means; these three groups of deliveries were compared with repeated cesarean delivery without labor.

Results Uterine rupture occurred at a rate of 1.6 per 1000 among women with repeated cesarean delivery without labor (11 women), 5.2 per 1000 among women with spontaneous onset of labor (56 women), 7.7 per 1000 among women whose labor was induced without prostaglandins (15 women), and 24.5 per 1000 among women with prostaglandin-induced labor (9 women). As compared with the risk in women with repeated cesarean delivery without labor, uterine rupture was more likely among women with spontaneous onset of labor (relative risk, 3.3; 95 percent confidence interval, 1.8 to 6.0), induction of labor without prostaglandins (relative risk, 4.9; 95 percent confidence interval, 2.4 to 9.7), and induction with prostaglandins (relative risk, 15.6; 95 percent confidence interval, 8.1 to 30.0).

Conclusions For women with one prior cesarean delivery, the risk of uterine rupture is higher among those whose labor is induced than among those with repeated cesarean delivery without labor. Labor induced with a prostaglandin confers the highest risk.

Source Information

From the Center for Women's Health Research, Department of Family and Child Nursing, School of Nursing (M.L.-R.), the Department of Epidemiology, School of Public Health and Community Medicine (V.L.H.), the Department of Obstetrics and Gynecology, School of Medicine (T.R.E.), and the Department of Health Services, School of Public Health and Community Medicine (M.L.-R., D.P.M.), University of Washington, Seattle.

Address reprint requests to Dr. Lydon-Rochelle at the Center for Women's Health Research, Mailstop 357262, University of Washington, Seattle, WA 98195-7262, or at minot{at}u.washington.edu.

Full Text of this Article

This article has been cited by other articles:

• Mercer, B. M., Gilbert, S., Landon, M. B., Spong, C. Y., Leveno, K. J., Rouse, D. J., Varner, M. W., Moawad, A. H., Simhan, H. N., Harper, M., Wapner, R. J., Sorokin, Y., Miodovnik, M., Carpenter, M., Peaceman, A., O'Sullivan, M. J., Sibai, B. M., Langer, O., Thorp, J. M., Ramin, S. M., for the National Institute of Child Health and Hum, (2008). Labor Outcomes With Increasing Number of Prior Vaginal Births After Cesarean Delivery. Obstet Gynecol 111: 285-291 [Abstract] [Full Text]  
• Ball, E., Hinshaw, K. (2007). The current management of vaginal birth after previous caesarean delivery. The Obstetrician and Gynaecologist 9: 77-82 [Abstract] [Full Text]  
• Grobman, W. A., Gilbert, S., Landon, M. B., Spong, C. Y., Leveno, K. J., Rouse, D. J., Varner, M. W., Moawad, A. H., Caritis, S. N., Harper, M., Wapner, R. J., Sorokin, Y., Miodovnik, M., Carpenter, M., O'Sullivan, M. J., Sibai, B. M., Langer, O., Thorp, J. M., Ramin, S. M., Mercer, B. M., for the National Institute of Child Heath and Huma, (2007). Outcomes of Induction of Labor After One Prior Cesarean. Obstet Gynecol 109: 262-269 [Abstract] [Full Text]  
• Hamilton, B. E., Minino, A. M., Martin, J. A., Kochanek, K. D., Strobino, D. M., Guyer, B. (2007). Annual Summary of Vital Statistics: 2005. Pediatrics 119: 345-360 [Abstract] [Full Text]  
• Agnew, G., Turner, M. (2006). Can a 29% Cesarean Delivery Rate Possibly Be Justified?. Obstet Gynecol 108: 452-452 [Full Text]  
• Hibbard, J. U., Gilbert, S., Landon, M. B., Hauth, J. C., Leveno, K. J., Spong, C. Y., Varner, M. W., Caritis, S. N., Harper, M., Wapner, R. J., Sorokin, Y., Miodovnik, M., Carpenter, M., Peaceman, A. M., O'Sullivan, M. J., Sibai, B. M., Langer, O., Thorp, J. M., Ramin, S. M., Mercer, B. M., Gabbe, S. G., for the National Institute of Child Health and Hum, (2006). Trial of Labor or Repeat Cesarean Delivery in Women With Morbid Obesity and Previous Cesarean Delivery.. Obstet Gynecol 108: 125-133 [Abstract] [Full Text]  
• Declercq, E., Menacker, F., MacDorman, M. (2006). Maternal Risk Profiles and the Primary Cesarean Rate in the United States, 1991-2002. Am. J. Public Health 96: 867-872 [Abstract] [Full Text]  
• Gonen, R., Nisenblat, V., Barak, S., Tamir, A., Ohel, G. (2006). Results of a Well-Defined Protocol for a Trial of Labor After Prior Cesarean Delivery. Obstet Gynecol 107: 240-245 [Abstract] [Full Text]  
• Salihu, H. M., Sharma, P. P., Kristensen, S., Blot, C., Alio, A. P., Ananth, C. V., Kirby, R. S. (2006). Risk of Stillbirth Following a Cesarean Delivery: Black-White Disparity. Obstet Gynecol 107: 383-390 [Abstract] [Full Text]  
• Hoyert, D. L., Mathews, T.J., Menacker, F., Strobino, D. M., Guyer, B. (2006). Annual Summary of Vital Statistics: 2004. Pediatrics 117: 168-183 [Abstract] [Full Text]  
• Nahum, G. G. (2005). Uterine Anomalies, Induction of Labor, and Uterine Rupture. Obstet Gynecol 106: 1150-1152 [Full Text]  
• Romano, P. S., Yasmeen, S., Schembri, M. E., Keyzer, J. M., Gilbert, W. M. (2005). Coding of Perineal Lacerations and Other Complications of Obstetric Care in Hospital Discharge Data. Obstet Gynecol 106: 717-725 [Abstract] [Full Text]  
• Juhasz, G., Gyamfi, C., Gyamfi, P., Tocce, K., Stone, J. L. (2005). Effect of Body Mass Index and Excessive Weight Gain on Success of Vaginal Birth After Cesarean Delivery. Obstet Gynecol 106: 741-746 [Abstract] [Full Text]  
• Quinones, J. N., Stamilio, D. M., Pare, E., Peipert, J. F., Stevens, E., Macones, G. A. (2005). The Effect of Prematurity on Vaginal Birth After Cesarean Delivery: Success and Maternal Morbidity. Obstet Gynecol 105: 519-524 [Abstract] [Full Text]  
• Martin, J. A., Kochanek, K. D., Strobino, D. M., Guyer, B., MacDorman, M. F. (2005). Annual Summary of Vital Statistics--2003. Pediatrics 115: 619-634 [Abstract] [Full Text]  
• Wu, J. M., Hundley, A. F., Visco, A. G. (2005). Elective Primary Cesarean Delivery: Attitudes of Urogynecology and Maternal-Fetal Medicine Specialists. Obstet Gynecol 105: 301-306 [Abstract] [Full Text]  
• Landon, M. B., Hauth, J. C., Leveno, K. J., Spong, C. Y., Leindecker, S., Varner, M. W., Moawad, A. H., Caritis, S. N., Harper, M., Wapner, R. J., Sorokin, Y., Miodovnik, M., Carpenter, M., Peaceman, A. M., O'Sullivan, M. J., Sibai, B., Langer, O., Thorp, J. M., Ramin, S. M., Mercer, B. M., Gabbe, S. G., the National Institute of Child Health and Human D, (2004). Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery. NEJM 351: 2581-2589 [Abstract] [Full Text]  
• Greene, M. F. (2004). Vaginal Birth after Cesarean Revisited. NEJM 351: 2647-2649 [Full Text]  
• Cheung, V. Y. T., Constantinescu, O. C., Ahluwalia, B. S. (2004). Sonographic Evaluation of the Lower Uterine Segment in Patients With Previous Cesarean Delivery. J Ultrasound Med 23: 1441-1447 [Abstract] [Full Text]  
• Lieberman, E., Ernst, E. K., Rooks, J. P., Stapleton, S., Flamm, B. (2004). Results of the National Study of Vaginal Birth After Cesarean in Birth Centers. Obstet Gynecol 104: 933-942 [Abstract] [Full Text]  
• Gyamfi, C., Juhasz, G., Gyamfi, P., Stone, J. L. (2004). Increased Success of Trial of Labor After Previous Vaginal Birth After Cesarean. Obstet Gynecol 104: 715-719 [Abstract] [Full Text]  
• Smith, G. C S, Pell, J. P, Pasupathy, D., Dobbie, R. (2004). Factors predisposing to perinatal death related to uterine rupture during attempted vaginal birth after caesarean section: retrospective cohort study. BMJ 329: 375- [Abstract] [Full Text]  
• Guise, J.-M., McDonagh, M. S, Osterweil, P., Nygren, P., Chan, B. K S, Helfand, M. (2004). Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section. BMJ 329: 19- [Abstract] [Full Text]  
• Carbillon, L. (2004). Vaginal Versus Cesarean Delivery for Breech Presentation in California: A Population-Based Study. Obstet Gynecol 103: 1003-1004 [Full Text]  
• Minkoff, H., Powderly, K. R., Chervenak, F., McCullough, L. B. (2004). Ethical Dimensions of Elective Primary Cesarean Delivery. Obstet Gynecol 103: 387-392 [Abstract] [Full Text]  
• Bujold, E., Blackwell, S. C., Gauthier, R. J. (2004). Cervical Ripening With Transcervical Foley Catheter and the Risk of Uterine Rupture. Obstet Gynecol 103: 18-23 [Abstract] [Full Text]  
• Arias, E., MacDorman, M. F., Strobino, D. M., Guyer, B. (2003). Annual Summary of Vital Statistics--2002. Pediatrics 112: 1215-1230 [Abstract] [Full Text]  
• Hamar, B. D., Levine, D., Katz, N. L., Lim, K.-H. (2003). Expectant Management of Uterine Dehiscence in the Second Trimester of Pregnancy. Obstet Gynecol 102: 1139-1142 [Abstract] [Full Text]  
• Shennan, A. H (2003). Recent developments in obstetrics. BMJ 327: 604-608 [Full Text]  
• Kass, N. E., Natowicz, M. R., Hull, S. C., Faden, R. R., Plantinga, L., Gostin, L. O., Slutsman, J. (2003). The Use of Medical Records in Research: What Do Patients Want?. J Law Med Ethics 31: 429-433  
• Delaney, T., Young, D. C. (2003). Spontaneous Versus Induced Labor After a Previous Cesarean Delivery. Obstet Gynecol 102: 39-44 [Abstract] [Full Text]  
• Sheldon, R. E., Escobedo, M. B., Cole, D. S., Dayal, A. K., Chazotte, C., Minkoff, H., Chervenak, F. A. (2003). Elective Primary Cesarean Delivery. NEJM 348: 2364-2365 [Full Text]  
• Li, T., Rhoads, G. G., Smulian, J., Demissie, K., Wartenberg, D., Kruse, L. (2003). Physician Cesarean Delivery Rates and Risk-Adjusted Perinatal Outcomes. Obstet Gynecol 101: 1204-1212 [Abstract] [Full Text]  
• Krebs, L., Langhoff-Roos, J. (2003). Elective Cesarean Delivery for Term Breech. Obstet Gynecol 101: 690-696 [Abstract] [Full Text]  
• Armstrong, V., Hansen, W. F., Van Voorhis, B. J., Syrop, C. H. (2003). Detection of Cesarean Scars by Transvaginal Ultrasound. Obstet Gynecol 101: 61-65 [Abstract] [Full Text]  
• MacDorman, M. F., Minino, A. M., Strobino, D. M., Guyer, B. (2002). Annual Summary of Vital Statistics--2001. Pediatrics 110: 1037-1052 [Abstract] [Full Text]  
• Howard, R. J., Straughn, J. M. Jr, Huh, W. K., Rouse, D. J. (2002). Pelvic Umbrella Pack for Refractory Obstetric Hemorrhage Secondary to Posterior Uterine Rupture. Obstet Gynecol 100: 1061-1063 [Abstract] [Full Text]  
• Kieser, K. E., Baskett, T. F. (2002). A 10-Year Population-Based Study of Uterine Rupture. Obstet Gynecol 100: 749-753 [Abstract] [Full Text]  
• Rayburn, W. F., Zhang, J. (2002). Rising Rates of Labor Induction: Present Concerns and Future Strategies. Obstet Gynecol 100: 164-167 [Abstract] [Full Text]  
• Harer, W. B. Jr (2002). Vaginal Birth After Cesarean Delivery: Current Status. JAMA 287: 2627-2630 [Full Text]  
• Smith, G. C. S., Pell, J. P., Cameron, A. D., Dobbie, R. (2002). Risk of Perinatal Death Associated With Labor After Previous Cesarean Delivery in Uncomplicated Term Pregnancies. JAMA 287: 2684-2690 [Abstract] [Full Text]  
• Carbillon, L., Uzan, M., Batallan, A., Bujold, E., Mehta, S. H., Gauthier, R. J. (2002). Should We Allow a Trial of Labor After a Previous Cesarean for Dystocia in the Second Stage of Labor?. Obstet Gynecol 99: 520-521 [Full Text]  
• Frohn, W. E., Simmons, S., Carlan, S. J. (2002). Prostaglandin E2 Gel Versus Misoprostol for Cervical Ripening in Patients With Premature Rupture of Membranes After 34 Weeks. Obstet Gynecol 99: 206-210 [Abstract] [Full Text]  
• Heffner, L. J., Weiss, J., Nannini, A., Bartlett, L., Declercq, E., Barger, M., O'Grady, J. P., Minkoff, H., McCalla, S., Koroukian, S. M., Magee, B. D., Lydon-Rochelle, M., Holt, V. L., Easterling, T. R., Greene, M. F. (2002). Uterine Rupture among Women with a Prior Cesarean Delivery. NEJM 346: 134-137 [Full Text]  
• (2001). Vaginal Birth After Cesarean: Labor Induction and Uterine Rupture. JWatch Women's Health 2001: 4-4 [Full Text]  
• (2001). Risk for Uterine Rupture with Vaginal Delivery After Cesarean Section. JWatch General 2001: 4-4 [Full Text]  
• Greene, M. F. (2001). Vaginal Delivery after Cesarean Section -- Is the Risk Acceptable?. NEJM 345: 54-55 [Full Text]  
• Grinstead, J., Grobman, W. A. (2000). Induction of Labor After One Prior Cesarean: Predictors of Vaginal Delivery. Obstet Gynecol 103: 534-538 [Abstract] [Full Text]  
• Ridgeway, J. J., Weyrich, D. L., Benedetti, T. J. (1997). Fetal Heart Rate Changes Associated With Uterine Rupture. Obstet Gynecol 103: 506-512 [Abstract] [Full Text]