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Abnormal Fetal Heart Rate Is Important Rupture Clue.
Uterine rupture rate of 1.7% in VBAC study.
KAMUELA, HAWAII -- A non-reassuring fetal heart rate tracing was the predominant sign of impending or actual uterine rupture in a community hospital study of women attempting a trial of labor after a prior cesarean section.
Uterine rupture occurred at a rate of 1.7% among 734 women attempting vaginal birth after cesarean section (VBAC) in a prospective cohort study; an additional 727 study participants elected not to have repeat cesarean sections, Dr. Howard Blanchette said at the annual meeting of the Pacific Coast Obstetrical and Gynecological Society.
Only 3 of the 13 patients who had a uterine rupture experienced pain, perhaps because all patients were given epidural anesthesia that may have "masked" that symptom. Just 2 of 13 cases were marked by a loss in intrauterine pressure, said Dr. Blanchette, chief of ob.gyn. at Danbury (Conn.) Hospital.
In contrast, 12 of 13 cases of uterine rupture were distinguished by abnormal fetal heart rates that preceded or accompanied rupture. Another red flag raised in the study was a strong apparent link to induction and! or augmentation of labor with misoprostol or oxytocin; only one rupture was recorded in a patient with spontaneous labor. Four of 13 patients with uterine rupture had two previous uterine scars.
To date, most studies of a trial of labor after cesarean birth have been done in academic, referral institutions, suggesting to Dr. Blanchette that his study's uterine rupture rate may be a more accurate reflection--or even an underestimation--of the national experience. Most previous studies on trial of labor have found a uterine rupture rate of one half to one percent.
As more community hospitals report their experience, it may become evident that VBAC is not the best alternative for all candidates or for every institution, he said. All participants in the current study were patients in the MetroWest Medical System, a group of community hospitals in the Framingham, Mass., ...
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