Prediction of uterine rupture associated with attempted vaginal birth after cesarean delivery.

Abstract

OBJECTIVE:

The purpose of this study was to develop a model that predicts individual-specific risk of uterine rupture during an attempted vaginal birth after cesarean delivery.

STUDY DESIGN:

Women with 1 previous low-transverse cesarean delivery who underwent a trial of labor with a term singleton were identified in a concurrently collected database of deliveries that occurred at 19 academic centers during a 4-year period. We analyzed different classification techniques in an effort to develop an accurate prediction model for uterine rupture.

RESULTS:

Of the 11,855 women who were available for analysis, 83 women (0.7%) had had a uterine rupture. The optimal final prediction model, which was based on a logistic regression, included 2 variables: any previous vaginal delivery (odds ratio, 0.44; 95% CI, 0.27-0.71) and induction of labor (odds ratio, 1.73; 95% CI, 1.11-2.69). This model, with a c-statistic of 0.627, had poor discriminating ability and did not allow the determination of a clinically useful estimate of the probability of uterine rupture for an individual patient.

CONCLUSION:

Factors that were available before or at admission for delivery cannot be used to predict accurately the relatively small proportion of women at term who will experience a uterine rupture during an attempted vaginal birth after cesarean delivery.

• Authors: William A Grobman, Yinglei Lai, Mark B Landon, Catherine Y Spong, Kenneth J Leveno, Dwight J Rouse, Michael W Varner, Atef H Moawad, Steve N Caritis, Margaret Harper, Ronald J Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Mary J O'Sullivan, Baha M Sibai, Oded Langer, John M Thorp, Susan M Ramin, Brian M Mercer, National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 199 Issue 1 Pg. 30.e1-5 (Jul 2008) ISSN: 1097-6868 [Electronic] United States
• PMID: 18439555 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Topics

• Adult
• Female
• Forecasting
• Humans
• Risk Factors
• Uterine Rupture (diagnosis, epidemiology, etiology)
• Vaginal Birth after Cesarean (adverse effects)