Unintended lower‐segment hysterotomy extension at cesarean delivery and the risk for uterine rupture during a subsequent trial of labor

Author:

Peled Tzuria1,Ashwal Eran2,Rotem Reut2ORCID,Sela Hen Y.1,Grisaru‐Granovsky Sorina1,Rottenstreich Misgav13

Affiliation:

1. Department of Obstetrics and Gynecology Shaare Zedek Medical Center affiliated with the Hebrew University School of Medicine Jerusalem Israel

2. Department of Obstetrics and Gynecology McMaster University Medical Center, McMaster University Hamilton Ontario Canada

3. Department of Nursing Jerusalem College of Technology Jerusalem Israel

Abstract

AbstractObjectiveTo evaluate the association between unintended uterine extension in cesarean delivery and uterine scar disruption (rupture or dehiscence) at the subsequent trial of labor after cesarean delivery (TOLAC).MethodsThis is a multicenter retrospective cohort study (2005–2021). Parturients with a singleton pregnancy who had unintended lower‐segment uterine extension during the primary cesarean delivery (excluding T and J vertical extensions) were compared with patients who did not have an unintended uterine extension. We assessed the subsequent uterine scar disruption rate following the subsequent TOLAC and the rate of adverse maternal outcome.ResultsDuring the study period, 7199 patients underwent a trial of labor and were eligible for the study, of whom 1245 (17.3%) had a previous unintended uterine extension and 5954 (82.7%) did not. In univariate analysis, previous unintended uterine extension during the primary cesarean delivery was not significantly associated with uterine scar rupture in the following subsequent TOLAC. Nevertheless, it was associated with uterine scar dehiscence, higher rates of TOLAC failure, and a composite adverse maternal outcome. In multivariate analyses, only the association between previous unintended uterine extension and higher rates of TOLAC failure was confirmed.ConclusionA history of unintended lower‐segment uterine extension is not associated with an increased risk for uterine scar disruption following subsequent TOLAC.

Publisher

Wiley

Subject

Obstetrics and Gynecology,General Medicine

Reference20 articles.

1. Births: final data for 2017;Martin JA;Natl Vital Stat Rep,2018

2. Delivery After Prior Cesarean: Success Rate and Factors

3. Royal College of Obstetricians & Gynaecologists.Birth after previous caesarean birth (Green‐top Guideline No. 45).2007.

4. ACOG practice bulletin no. 115: vaginal birth after previous cesarean delivery;ACOG;Obstet Gynecol,2010

5. Risk score for failed trial of vaginal birth after a previous cesarean section including data of labor course

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