Uterine Rupture Risk Increased With Multiple Cesarean Sections

Aside from the inherent risks associated with the major surgery, pregnant women have another reason to avoid cesarean sections when possible: A recent study as published in the journal PLoS Medicine concludes that the risk of uterine rupture is increased for women who have had multiple cesarean births.

Uterine rupture is a serious medical complication associated with pregnancy and labor in which the wall of the uterus tears or separates that can result in death. Researchers in the present study concluded a maternal fatality rate of 1.3 percent and an infant fatality rate of 12.4 percent associated with uterine rupture. (The overall infant mortality rate in the United Kingdom is 0.75 percent.)

For a woman to experience a uterine rupture is extremely rare; however, the risk increases with each cesarean section that a woman has.

Researchers in the National Perinatal Epidemiology Unit based at the University of Oxford looked at 159 women who had experienced a uterine rupture between April 2009 and April 2010. Of the 159, 87 percent (139 of 159) had previously given birth by cesarean section.

Furthermore, although the general rate of uterine rupture among pregnant women was 0.02 percent, women who had had one previous cesarean section had a uterine rupture rate of 0.21% for vaginal births and 0.03% for repeat cesarean births. A woman’s risk for uterine rupture continued to increase with each cesarean section she had had.

Women who have had previous cesarean births had previously been warned against trying for a vaginal birth after cesarean (VBAC) because of the risk of uterine rupture during labor. However, the results of this study indicate that the increased risk of uterine rupture applies to both vaginal births and cesarean births. As the authors of the study state:

“For women with a previous caesarean section, the risk of uterine rupture increases not only with trial of labour but also with the number of previous caesarean deliveries, a short interval since the last caesarean section, and labour induction and/or augmentation. These factors should be considered when counselling and managing the labour of women with a previous caesarean section.”

Additionally, the results of this study should be a factor when doctors and women are considering an initial cesarean section.

As Catherine Spong from the National Institute of Child Health and Human Development (not involved in the present research) concludes:

“Given the major complications associated with multiple cesareans, to both mother and baby, women should carefully evaluate the immediate risks in the current pregnancy with the longer-term risks of multiple cesareans.”

Despite the increased risk of uterine rupture, however, women who have previously given birth via cesarean section should know that the risk of uterine rupture overall still remains low.

Do you think that the results of this study will have a positive impact on current high rates of cesarean sections?