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Obstetrics & Gynecology 2008;111:648-653
© 2008 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Previous Preterm Cesarean Delivery and Risk of Subsequent Uterine Rupture

Anthony C. Sciscione, DO1, Mark B. Landon, MD2, Kenneth J. Leveno, MD3, Catherine Y. Spong, MD4, Cora MacPherson, PhD5, Michael W. Varner, MD6, Dwight J. Rouse, MD7, Atef H. Moawad, MD8, Steve N. Caritis, MD9, Margaret Harper, MD, MS10, Yoram Sorokin, MD11, Menachem Miodovnik, MD12,13, Carpenter Marshall, MD14, Alan M. Peaceman, MD15, Mary J. O’Sullivan, MD16, Baha M. Sibai, MD17, Oded Langer, MD18, John M. Thorp, MD19, Susan M. Ramin, MD20, Brian M. Mercer, MD21 for the National Institute of Child Health and Human Development (NICHD) Maternal–Fetal Medicine Units Network (MFMU)*

From the 1Departments of Obstetrics and Gynecology at Christiana Care Health System, Newark, Delaware; 2Ohio State University, Columbus, Ohio; 3University of Texas Southwestern Medical Center, Dallas, Texas; 4National Institute of Child Health and Human Development, Bethesda, Maryland; 5the George Washington University Biostatistics Center, Washington, DC; 6University of Utah, Salt Lake City, Utah; 7University of Alabama at Birmingham, Birmingham, Alabama; 8University of Chicago, Chicago, Illinois; 9University of Pittsburgh, Pittsburgh, Pennsylvania; 10Wake Forest University, Winston-Salem, North Carolina; 11Wayne State University, Detroit, Michigan; 12University of Cincinnati, Cincinnati, Ohio; 13Columbia University, New York, New York; 14Brown University, Providence, Rhode Island; 15Northwestern University, Chicago, Illinois; 16University of Miami, Miami, Florida; 17University of Tennessee, Memphis, Tennessee; 18University of Texas at San Antonio, San Antonio, Texas; 19University of North Carolina, Chapel Hill, North Carolina; 20University of Texas at Houston, Houston, Texas; and 21Case Western Reserve University, Cleveland, Ohio.

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.

LEVEL OF EVIDENCE: II






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