Risks and Outcomes of Uterine Rupture in Women With and Without a Trial of Labour

Abstract

Objectives

The study aimed to evaluate the maternal and neonatal outcomes in patients who experienced uterine rupture, comparing those who underwent a trial of labour to those who did not.

Methods

A population-based retrospective study was conducted in a tertiary university medical centre from 2008 to 2019. The cohort consisted of all women who were diagnosed with uterine rupture during cesarean delivery (CD) or laparotomy. Patients with 1 previous CD who underwent a trial of labour (TOLAC group) were compared against patients who had a history of CD in whom no trial of labour occurred, and/or against patients who had no prior CD in whom a ruptured uterus was diagnosed during or following delivery (no-TOLAC group). Patients with uterine scar dehiscence were excluded.

Results

Of 103 542 women who gave birth during the study period, 10 325 had a previous CD. Uterine rupture occurred in 95 cases: 55 among patients who had undergone TOLAC (0.98%) and 40 (0.85%) without trial of labour. Compared with the TOLAC group, the subgroup of women with a single prior CD who did not attempt TOLAC (n = 16) had a higher rate of neonatal intensive care unit admission (56.3% vs. 21.7%, OR 4.15; 95% CI 1.3–13.3, P = 0.01) and adverse composite maternal outcomes (blood transfusion, urinary bladder injury, and/or intensive care unit admission) (75% vs. 30.9%, OR 6.7; 95% CI 1.8–23.8, P < 0.01). There was no neonatal or maternal death in any group.

Conclusions

Despite the higher incidence of uterine rupture in women undergoing TOLAC, outcomes are less favourable when rupture occurs outside the trial of labour and if the uterus is unscarred.