Previous preterm cesarean delivery and risk of subsequent uterine rupture

Anthony C. Sciscione; Mark B. Landon; Kenneth J. Leveno; Catherine Y. Spong; Cora MacPherson; Michael W. Varner; Dwight J. Rouse; Atef H. Moawad; Steve N. Caritis; Margaret Harper; Yoram Sorokin; Menachem Miodovnik; Carpenter Marshall; Alan M. Peaceman; Mary J. O'Sullivan; Baha M. Sibai; Oded Langer; John M. Thorp; Susan M. Ramin; Brian M. Mercer

doi:10.1097/AOG.0b013e318163cd3e

Previous preterm cesarean delivery and risk of subsequent uterine rupture

Anthony C. Sciscione, Mark B. Landon, Kenneth J. Leveno, Catherine Y. Spong, Cora MacPherson, Michael W. Varner, Dwight J. Rouse, Atef H. Moawad, Steve N. Caritis, Margaret Harper, Yoram Sorokin, Menachem Miodovnik, Carpenter Marshall, Alan M. Peaceman, Mary J. O'Sullivan, Baha M. Sibai, Oded Langer, John M. Thorp, Susan M. Ramin, Brian M. Mercer

Obstetrics and Gynecology

Research output: Contribution to journal › Article › peer-review

47 Scopus citations

Abstract

OBJECTIVE: To determine if women with a history of a previous preterm cesarean delivery experienced an increased risk of subsequent uterine rupture compared with women who had a previous nonclassic term cesarean delivery. METHODS: A prospective observational study was performed in singleton gestations that had a previous nonclassic cesarean delivery from 1999 to 2002. Women with a history of a previous preterm cesarean delivery were compared with women who had a previous term cesarean delivery. Women who had both a preterm and term cesarean delivery were included in the preterm group. RESULTS: A prior preterm cesarean delivery was significantly associated with an increased risk of subsequent uterine rupture (0.58% compared with 0.28%, P<.001). When women who had a subsequent elective cesarean delivery were removed (remaining n=26,454) women with a previous preterm cesarean delivery were still significantly more likely to sustain a uterine rupture (0.79% compared with 0.46%, P=.001). However, when only women who had a subsequent trial of labor were included, there was still an absolute increased risk of uterine rupture, but it was not statistically significant (1.00% compared with 0.68%, P=.081). In a multivariable analysis controlling for confounding variables (oxytocin use, two or more previous cesarean deliveries, a cesarean delivery within the past 2 years, and preterm delivery in the current pregnancy), patients with a previous preterm cesarean delivery remained at an increased risk of subsequent uterine rupture (P=.043, odds ratio 1.6, 95% confidence interval 1.01-2.50) compared with women with previous term cesarean delivery. CONCLUSION: Women who have had a previous preterm cesarean delivery are at a minimally increased risk for uterine rupture in a subsequent pregnancy when compared with women who have had previous term cesarean deliveries.

Original language	English (US)
Pages (from-to)	648-653
Number of pages	6
Journal	Obstetrics and gynecology
Volume	111
Issue number	3
DOIs	https://doi.org/10.1097/AOG.0b013e318163cd3e
State	Published - Mar 2008

ASJC Scopus subject areas

Obstetrics and Gynecology

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10.1097/AOG.0b013e318163cd3e

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Sciscione, A. C., Landon, M. B., Leveno, K. J., Spong, C. Y., MacPherson, C., Varner, M. W., Rouse, D. J., Moawad, A. H., Caritis, S. N., Harper, M., Sorokin, Y., Miodovnik, M., Marshall, C., Peaceman, A. M., O'Sullivan, M. J., Sibai, B. M., Langer, O., Thorp, J. M., Ramin, S. M., & Mercer, B. M. (2008). Previous preterm cesarean delivery and risk of subsequent uterine rupture. Obstetrics and gynecology, 111(3), 648-653. https://doi.org/10.1097/AOG.0b013e318163cd3e

@article{1e001e732c2946cabe95486b489e0509,

title = "Previous preterm cesarean delivery and risk of subsequent uterine rupture",

abstract = "OBJECTIVE: To determine if women with a history of a previous preterm cesarean delivery experienced an increased risk of subsequent uterine rupture compared with women who had a previous nonclassic term cesarean delivery. METHODS: A prospective observational study was performed in singleton gestations that had a previous nonclassic cesarean delivery from 1999 to 2002. Women with a history of a previous preterm cesarean delivery were compared with women who had a previous term cesarean delivery. Women who had both a preterm and term cesarean delivery were included in the preterm group. RESULTS: A prior preterm cesarean delivery was significantly associated with an increased risk of subsequent uterine rupture (0.58% compared with 0.28%, P<.001). When women who had a subsequent elective cesarean delivery were removed (remaining n=26,454) women with a previous preterm cesarean delivery were still significantly more likely to sustain a uterine rupture (0.79% compared with 0.46%, P=.001). However, when only women who had a subsequent trial of labor were included, there was still an absolute increased risk of uterine rupture, but it was not statistically significant (1.00% compared with 0.68%, P=.081). In a multivariable analysis controlling for confounding variables (oxytocin use, two or more previous cesarean deliveries, a cesarean delivery within the past 2 years, and preterm delivery in the current pregnancy), patients with a previous preterm cesarean delivery remained at an increased risk of subsequent uterine rupture (P=.043, odds ratio 1.6, 95% confidence interval 1.01-2.50) compared with women with previous term cesarean delivery. CONCLUSION: Women who have had a previous preterm cesarean delivery are at a minimally increased risk for uterine rupture in a subsequent pregnancy when compared with women who have had previous term cesarean deliveries.",

author = "Sciscione, {Anthony C.} and Landon, {Mark B.} and Leveno, {Kenneth J.} and Spong, {Catherine Y.} and Cora MacPherson and Varner, {Michael W.} and Rouse, {Dwight J.} and Moawad, {Atef H.} and Caritis, {Steve N.} and Margaret Harper and Yoram Sorokin and Menachem Miodovnik and Carpenter Marshall and Peaceman, {Alan M.} and O'Sullivan, {Mary J.} and Sibai, {Baha M.} and Oded Langer and Thorp, {John M.} and Ramin, {Susan M.} and Mercer, {Brian M.}",

year = "2008",

month = mar,

doi = "10.1097/AOG.0b013e318163cd3e",

language = "English (US)",

volume = "111",

pages = "648--653",

journal = "Obstetrics and gynecology",

issn = "0029-7844",

publisher = "Lippincott Williams and Wilkins",

number = "3",

}

Sciscione, AC, Landon, MB, Leveno, KJ, Spong, CY, MacPherson, C, Varner, MW, Rouse, DJ, Moawad, AH, Caritis, SN, Harper, M, Sorokin, Y, Miodovnik, M, Marshall, C, Peaceman, AM, O'Sullivan, MJ, Sibai, BM, Langer, O, Thorp, JM, Ramin, SM & Mercer, BM 2008, 'Previous preterm cesarean delivery and risk of subsequent uterine rupture', Obstetrics and gynecology, vol. 111, no. 3, pp. 648-653. https://doi.org/10.1097/AOG.0b013e318163cd3e

TY - JOUR

T1 - Previous preterm cesarean delivery and risk of subsequent uterine rupture

AU - Sciscione, Anthony C.

AU - Landon, Mark B.

AU - Leveno, Kenneth J.

AU - Spong, Catherine Y.

AU - MacPherson, Cora

AU - Varner, Michael W.

AU - Rouse, Dwight J.

AU - Moawad, Atef H.

AU - Caritis, Steve N.

AU - Harper, Margaret

AU - Sorokin, Yoram

AU - Miodovnik, Menachem

AU - Marshall, Carpenter

AU - Peaceman, Alan M.

AU - O'Sullivan, Mary J.

AU - Sibai, Baha M.

AU - Langer, Oded

AU - Thorp, John M.

AU - Ramin, Susan M.

AU - Mercer, Brian M.

PY - 2008/3

Y1 - 2008/3

N2 - OBJECTIVE: To determine if women with a history of a previous preterm cesarean delivery experienced an increased risk of subsequent uterine rupture compared with women who had a previous nonclassic term cesarean delivery. METHODS: A prospective observational study was performed in singleton gestations that had a previous nonclassic cesarean delivery from 1999 to 2002. Women with a history of a previous preterm cesarean delivery were compared with women who had a previous term cesarean delivery. Women who had both a preterm and term cesarean delivery were included in the preterm group. RESULTS: A prior preterm cesarean delivery was significantly associated with an increased risk of subsequent uterine rupture (0.58% compared with 0.28%, P<.001). When women who had a subsequent elective cesarean delivery were removed (remaining n=26,454) women with a previous preterm cesarean delivery were still significantly more likely to sustain a uterine rupture (0.79% compared with 0.46%, P=.001). However, when only women who had a subsequent trial of labor were included, there was still an absolute increased risk of uterine rupture, but it was not statistically significant (1.00% compared with 0.68%, P=.081). In a multivariable analysis controlling for confounding variables (oxytocin use, two or more previous cesarean deliveries, a cesarean delivery within the past 2 years, and preterm delivery in the current pregnancy), patients with a previous preterm cesarean delivery remained at an increased risk of subsequent uterine rupture (P=.043, odds ratio 1.6, 95% confidence interval 1.01-2.50) compared with women with previous term cesarean delivery. CONCLUSION: Women who have had a previous preterm cesarean delivery are at a minimally increased risk for uterine rupture in a subsequent pregnancy when compared with women who have had previous term cesarean deliveries.

AB - OBJECTIVE: To determine if women with a history of a previous preterm cesarean delivery experienced an increased risk of subsequent uterine rupture compared with women who had a previous nonclassic term cesarean delivery. METHODS: A prospective observational study was performed in singleton gestations that had a previous nonclassic cesarean delivery from 1999 to 2002. Women with a history of a previous preterm cesarean delivery were compared with women who had a previous term cesarean delivery. Women who had both a preterm and term cesarean delivery were included in the preterm group. RESULTS: A prior preterm cesarean delivery was significantly associated with an increased risk of subsequent uterine rupture (0.58% compared with 0.28%, P<.001). When women who had a subsequent elective cesarean delivery were removed (remaining n=26,454) women with a previous preterm cesarean delivery were still significantly more likely to sustain a uterine rupture (0.79% compared with 0.46%, P=.001). However, when only women who had a subsequent trial of labor were included, there was still an absolute increased risk of uterine rupture, but it was not statistically significant (1.00% compared with 0.68%, P=.081). In a multivariable analysis controlling for confounding variables (oxytocin use, two or more previous cesarean deliveries, a cesarean delivery within the past 2 years, and preterm delivery in the current pregnancy), patients with a previous preterm cesarean delivery remained at an increased risk of subsequent uterine rupture (P=.043, odds ratio 1.6, 95% confidence interval 1.01-2.50) compared with women with previous term cesarean delivery. CONCLUSION: Women who have had a previous preterm cesarean delivery are at a minimally increased risk for uterine rupture in a subsequent pregnancy when compared with women who have had previous term cesarean deliveries.

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U2 - 10.1097/AOG.0b013e318163cd3e

DO - 10.1097/AOG.0b013e318163cd3e

M3 - Article

C2 - 18310367

AN - SCOPUS:42449106964

SN - 0029-7844

VL - 111

SP - 648

EP - 653

JO - Obstetrics and gynecology

JF - Obstetrics and gynecology

IS - 3

ER -

Previous preterm cesarean delivery and risk of subsequent uterine rupture

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