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Ruptured uterus following previous caesarean section – revisiting the NICE guideline
  1. P Wu,
  2. A Gumma
  1. Peterborough and Stamford Hospitals NHS Trust, Peterborough, UK

Abstract

Brief Summary of Cases This report summarises three cases of uterine rupture diagnosed at Caesarean section (CS) over 2 months in our unit with 4000 deliveries per annum, which uses Prostin for induction of labour (IOL) in vaginal birth after Caesarean. These patients each had one CS for breech previously.

Patient 1 had IOL at 40+12. Variable decelerations were noted at 4 cm cervical dilatation and fetal bradycardia prompted a CS. Patient 2 was induced at 40+10. After artificial rupture of membranes (ARM) at 3 cm cervical dilatation, she was on Syntocinon for 2 h. Due to cardiotocograph (CTG) concerns, a CS was performed. Patient 3 had recurrent per vaginal bleeding (PVB) antenatally and was induced at 39+4 for maternal mental health. ARM at 3 cm cervical dilatation with 3-h Syntocinon augmentation was followed by fetal bradycardia at 9 cm dilatation with PVB and led to a CS.

Discussion Currently, the NICE guideline on IOL states vaginal prostaglandin is the preferred method for women with previous CS, and quotes risk of rupture as 0.35–2.4%.1 However, Royal College of Obstetricians and Gynaecologists green-top guideline suggests a higher risk of rupture with IOL using prostaglandins compared with other methods, and quotes risk of rupture as 102/10 000 in induced, 87/10 000 in augmented vs 36/10 000 in spontaneous labours.2 Given the severe consequences of uterine rupture, our approach towards IOL may need to be reconsidered based on informed choice.

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