The risk of rupture of the uterus: an analysis of 1086 births after previous caesarean section

In the work presented here, obstetric management after a previous caesarean section was studied in a large patient group at the University Department of Gynecology and Obstetrics in Cologne from 1979 to 1995. Particular attention was given to the feared complication of uterine rupture. From a total of 15 166 deliveries, 1086 of the births had been preceded by one or more caesarean sections. These 1086 births formed the basis for the present study. Vaginal delivery was attempted in 44.5% of patients and was successful in 86% of those cases. Where there had been only one previous caesarean section, the percentage shifted in favor of vaginal delivery. All patients with more than two previous caesarean sections were delivered by elective caesarean section. The feared complication of rupture of the uterus occurred in four cases, for which case reports are presented. In view of such cases, signs of imminent uterus rupture often constitute an indication for elective (11.5%) or emergency resectioning (31.9%). No relationship was found between fetal outcome and mode of delivery. This retrospective study confirms the general recommendation and safety of vaginal delivery after a previous caesarean section as long as risks are minimised by a readiness to proceed with a repeat caesarean when signs of imminent rupture of the uterus arise.