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VBACs and Uterine Rupture
Risk of Uterine Rupture during Labor among women With a Prior Cesarean Section. Lyndon-Rochelle M, Holt VL, Easterling TP, et al. N Engl J Med 2001 (Jul 5); 345: 3-8).
A retrospective, cohort analysis was done using data from all primiparous women who gave birth to live singleton infants by cesarean section in Washington State from 1987 through 1996, and delivered a second singleton child during the same period (n = 20,095 women). Uterine rupture occurred at a rate of 1.6 / 1000 women with repeated cesarean delivery without labor, 5.2 / 1000 among women with spontaneous onset of labor, 7.7 / 1000 when labor was induced without prostaglandins, and 24.5 / 1000 among women with prostaglandin-induced labor. As compared with the risk in women with repeated cesarean delivery without labor, uterine rupture was 3.3x more likely among women with spontaneous labor, 4.9x more likely if induced without prostaglandins, and 15.6x more likely with prostaglandin inductions.
Comment. Our obstetric colleagues are expected to counsel potential VBAC candidates about the relative risks of vaginal delivery versus repeat cesarean section. The strength of this study is the large sample size. Over 20,000 women can’t be wrong. The risk of uterine rupture with VBAC deliveries is real, and that risk dramatically increases if labor is induced, especially if prostaglandins are used for induction. These data should be shared with VBAC candidates when obtaining informed consent for a trial of labor.