Introduction The relentless rise in the caesarean section (CS) rate has been associated with a decrease in the vaginal birth after caesarean (VBAC) rate possibly due concerns about the safety of a trial of labour after CS (TOLAC). The purpose of this study was to assess the risk of uterine rupture and maternal and perinatal complications associated with uterine rupture in women undergoing a TOLAC.
Methods A retrospective study was performed in a tertiary referral hospital. Records were reviewed for the years 1990-2010. Only women with one previous caesarean section were allowed undergo a trial of labour. Uterine rupture was defined as disruption of the uterine muscle involving the uterine serosa or disruption of the uterine muscle with extension to the bladder or broad ligament.
Results From 1990-2009 there were 88,668 multigravidas delivered of a baby weighing >500g and 14,832 had one previous CS. The CS rate increased from 11.3% in 1990 to 25.1% in 2009 and the VBAC rate decreased from 75.0% to 57.1%. There were 30 cases of uterine rupture in women with one previous CS during this time. Uterine rupture was associated with the use of prostaglandin to induce labour (n=2) and oxytocin to induce or augment labour (n=14). There were no maternal deaths or peripartum hysterectomies performed after uterine rupture. There was one perinatal death due to prematurity and one baby with neurological abnormality after uterine rupture.
Conclusion VBAC remains a safe mode of delivery for mother and baby with a low risk of uterine rupture.
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