Risk factors for uterine dehiscence and rupture in case of vaginal birth after cesarean section

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Published Oct 8, 2024
https://doi.org/10.62438/tunismed.v102i10.5015
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Vol. 102 No. 10 (2024): Tunis Med oct 2024

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Hana Hakim
Department of Obstetrics and Gynaecology, Hedi Chaker Hospital, Sfax. Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
Mohamed Derbel
Department of Obstetrics and Gynaecology, Hedi Chaker Hospital, Sfax. Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
Hajer Mtibaa
Department of Obstetrics and Gynaecology, Hedi Chaker Hospital, Sfax. Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
Basma Akrout
Department of Obstetrics and Gynaecology, Hedi Chaker Hospital, Sfax. Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
Khaled Trigui
Department of Obstetrics and Gynaecology, Hedi Chaker Hospital, Sfax. Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
Fatma Chaker
Department of Obstetrics and Gynaecology, Hedi Chaker Hospital, Sfax. Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
Fatma Khanfir
Department of Obstetrics and Gynaecology, Hedi Chaker Hospital, Sfax. Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
Kais Chaabane
Department of Obstetrics and Gynaecology, Hedi Chaker Hospital, Sfax. Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia

Abstract

Introduction: Vaginal delivery after caesarean section (VBAC) is recommended, but  the rising rate of uterine rupture calls into question the safety of this practice.


Aim: To identify risk factors for uterine dehiscence and rupture.


Methods: This was a prospective, analytical and descriptive observational study, carried out in a tertiary care maternity. We included all parturients with one previous caesarean section undergoing trial of labor. We assessed the quality of the uterine scar which was evaluated after delivery.


Results: We included 300 patients with one previous caesarean section undergoing trial of labor. The trial of labor was successful (vaginal delivery) in 50.7% of cases. The uterine scar, assessed after delivery, was of good quality in 79% of cases. We noted 7 cases of uterine rupture, i.e. 2.3% of cases, and dehiscence in 56 patients, i.e. 18.6% of cases. Parity, conditions of previous caesarean section (programmed or emergency) and interpregnancy interval were significantly related to the labor outcome (p=0.004, p=0.001 and p=0.135 respectively). The occurrence of rupture or dehiscence was not significantly related to macrosomia, defined as a neonatal weight greater than 4000g (p=0.135).


Conclusion: Knowing the risk factors for uterine dehiscence and rupture would enable the obstetrician to properly assess the situation in order to make the correct decision and avoid neonatal and maternal complications.

Keywords:

risk factor , cesarean section, rupture, dehiscence

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References

  1. Laurent E, Lecuyer AI, Baron S, Turpin D, Potin J, Grammatico-Guillon L. Césariennes programmées en Centre-Val de Loire : pratiques et Indications – Comparaison des taux selon la classification de Robson. Revue d’Épidémiologie et de Santé Publique. mars 2019;67:S81.
  2. Hellerstein S, Feldman S, Duan T. China’s 50% caesarean delivery rate: is it too high? BJOG. janv 2015;122(2):160‑4.
  3. Betran AP, Torloni MR, Zhang JJ, Gülmezoglu AM, WHO Working Group on Caesarean Section. WHO Statement on Caesarean Section Rates. BJOG. avr 2016;123(5):667‑70.
  4. Rozenberg P, Deruelle P, Sénat MV, Desbrière R, Winer N, Simon E, et al. [Lower Uterine Segment Trial: A pragmatic open multicenter randomized trial]. Gynecol Obstet Fertil Senol. avr 2018;46(4):427‑32.
  5. Al-Zirqi I, Daltveit AK, Forsén L, Stray-Pedersen B, Vangen S. Risk factors for complete uterine rupture. Am J Obstet Gynecol. févr 2017;216(2):165.e1-165.e8.
  6. Parant O. Rupture utérine : prédiction, diagnostic et prise en charge. Journal de Gynécologie Obstétrique et Biologie de la Reproduction. déc 2012;41(8):803‑16.
  7. Mei JY, Havard AL, Mularz AJ, Maykin MM, Gaw SL. Impact of obesity class on trial of labor after cesarean success: does pre-pregnancy or at-delivery obesity status matter? J Perinatol. août 2019;39(8):1042‑9.
  8. Yao R, Goetzinger KR, Crimmins SD, Kopelman JN, Contag SA. Association of Maternal Obesity With Maternal and Neonatal Outcomes in Cases of Uterine Rupture. Obstet Gynecol. avr 2017;129(4):683‑8.
  9. Wu Y, Kataria Y, Wang Z, Ming WK, Ellervik C. Factors associated with successful vaginal birth after a cesarean section: a systematic review and meta-analysis. BMC Pregnancy Childbirth. déc 2019;19(1):360.
  10. Kayem G, Raiffort C, Legardeur H, Gavard L, Mandelbrot L, Girard G. Critères d’acceptation de la voie vaginale selon les caractéristiques de la cicatrice utérine. Journal de Gynécologie Obstétrique et Biologie de la Reproduction. déc 2012;41(8):753‑71.
  11. Barger MK, Nannini A, Weiss J, Declercq ER, Stubblefield P, Werler M, et al. Severe maternal and perinatal outcomes from uterine rupture among women at term with a trial of labor. J Perinatol. nov 2012;32(11):837‑43.
  12. Koh VM, Essome H, Sama JD, Foumane P, Ebah BM. [Vaginal birth after previous cesarean section in low-resource countries: healthcare chain and materno-fetal follow-up]. Pan Afr Med J. 2018;30:255.
  13. Guo N, Bai RM, Qu PF, Huang P, He YP, Wang CL, et al. [Influencing factors and antenatal assessment of the vaginal birth after cesarean section]. Zhonghua Fu Chan Ke Za Zhi. 25 juin 2019;54(6):369‑74.
  14. Swift BE, Shah PS, Farine D. Sonographic lower uterine segment thickness after prior cesarean section to predict uterine rupture: A systematic review and meta-analysis. Acta Obstet Gynecol Scand. juill 2019;98(7):830‑41.
  15. Sananès N, Rodriguez M, Stora C, Pinton A, Fritz G, Gaudineau A, et al. Efficacy and safety of labour induction in patients with a single previous caesarean section: a proposal for a clinical protocol. Arch Gynecol Obstet. oct 2014;290(4):669‑76.
  16. Philémon MUMBERE MATUMO, Joël KAMBALE KETHA, Aimé LUKWAMIRE VAHAMWITI, and Jean-Jeannot JUAKALI SIHALIKYOLO VUYIAMBITE, “Prognosis of labour among pregnant women with scarred uteri in Butembo, Democratic Republic of the Congo,” International Journal of Innovation and Applied Studies, vol. 24, no. 4, pp. 1750–1760, November 2018.
  17. Lofrumento DD, Di Nardo MA, De Falco M, Di Lieto A. Uterine Wound Healing: A Complex Process Mediated by Proteins and Peptides. Curr Protein Pept Sci. 2017;18(2):125‑8.
  18. Lannon SMR, Guthrie KA, Vanderhoeven JP, Gammill HS. Uterine rupture risk after periviable cesarean delivery. Obstet Gynecol. mai 2015;125(5):1095‑100.
  19. Al-Zirqi I, Stray-Pedersen B, Forsén L, Vangen S. Uterine rupture after previous caesarean section. BJOG. juin 2010;117(7):809‑20.
  20. Alemu AA, Bitew MS, Gelaw KA, Zeleke LB, Kassa GM. Prevalence and determinants of uterine rupture in Ethiopia: a systematic review and meta-analysis. Sci Rep. 19 oct 2020;10(1):17603.