Unintended lower-segment hysterotomy extension at cesarean delivery and the risk for uterine rupture during a subsequent trial of labor.
cesarean delivery
hysterotomy
trial of labor
uterine incision extension
Journal
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
ISSN: 1879-3479
Titre abrégé: Int J Gynaecol Obstet
Pays: United States
ID NLM: 0210174
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
revised:
12
03
2023
received:
29
11
2022
accepted:
28
03
2023
medline:
15
8
2023
pubmed:
19
4
2023
entrez:
19
04
2023
Statut:
ppublish
Résumé
To 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). This 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. During 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. A history of unintended lower-segment uterine extension is not associated with an increased risk for uterine scar disruption following subsequent TOLAC.
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
957-963Informations de copyright
© 2023 International Federation of Gynecology and Obstetrics.
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