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Catastrophic uterine rupture during labor: VBAC-related perinatal deaths more common in smaller hospitals.(Obstetrics)
HOUSTON -- Fetal deaths caused by catastrophic uterine ruptures were a rare event and occurred most often in small hospitals in a study of nearly 36,000 Scottish women who attempted to have a vaginal birth after a previous cesarean delivery.
A number of factors were associated with uterine rupture and also with perinatal mortality in a study that linked registries of all births and perinatal deaths in Scotland from 1985 to 1998, Dr. Gordon C.S. Smith of Cambridge (England) University reported at the annual meeting of the Society for Gynecologic Investigation.
A total of 124 uterine ruptures (1 in 290) and 17 associated perinatal deaths (1 in 2,100) were identified in 35,854 records of women attempting VBAC for a singleton term birth after one prior cesarean section.
The lack of a previous vaginal delivery, labor induced by prostaglandin, and macrosomia were each associated with an increased relative risk of uterine rupture and perinatal death. (See table.)
But when Dr. Smith and his associates studied catastrophic consequences of uterine rupture, rather than including asymptomatic dehiscences discovered during cesarean deliveries, an unexpected risk emerged.
Among ...
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