Results of studies comparing trial of labour and emergency repeat caesarean delivery
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Sample size
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No (%) of uterine ruptures
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Study
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Characteristics of population
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TOL
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ERCD
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Uterine exploration
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Symptomatic
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Asymptomatic
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Reported associated major morbidity
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Cowan 199412
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All vertical scars excluded; unclassified scars and more than 1 previous caesarean allowed
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593
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Not reported
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TOL - 5 (0.8)
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Not reported
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1 fetus with severe neurological sequelae
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Flamm 199415
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All vertical scars excluded; unclassified scars allowed
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5022
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2207
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Discretion
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TOL - 39 (0.8)
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Not reported
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0 maternal and neonatal deaths, 3/39 hysterectomies
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Duff 198813
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One prior LTCD and unclassified scar not allowed
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227*
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Yes
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TOL - 1 (0.4)
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Not reported
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0 maternal or perinatal deaths
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Flamm 198814
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LTCD, unclassified scar and more than 1 previous caesarean allowed
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1776
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Yes (discretion?)
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TOL - 3 (0.2)
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TOL - 11 (0.6)
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Symptomatic UR: TOL - 0 maternal and neonatal deaths, 1 hysterectomy
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Flamm 199016
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LTCD, unclassified scars and more than 1 previous caesarean allowed
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3957
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Majority no longer did
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TOL - 7 (0.2)
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Not reported
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0 maternal deaths; 1 hysterectomy with infant born vaginally, Apgar 9; 3 infants with Apgar <7 (one cerebral palsy at 15 months); 1 perinatal death related to rupture
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Phelan 198721
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Low vertical scars, unclassified scars, LTCD during 2nd year and more than 1 previous caesarean allowed
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1796
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314
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Yes
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TOL - 5 (0.3)
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TOL - 34 (1.9) ERCD - 7 (2.2)
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Symptomatic UR: TOL - 1 neonatal death, post rupture, scar intact, fetal bradycardia (sign), 4600g Apgar 0,0,3; none in transverse scar
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Stoval 198722
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More than 1 LTCD or LVCD allowed; not clear what was done with unclassified scars
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272
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Yes
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TOL - 1 (0.4)
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TOL - 6 (2.2)
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Symptomatic UR: TOL - 0 maternal or fetal deaths
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Paul 198520
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Not more than 1 previous caesarean allowed; low vertical scars, unclassified scars and LTCD allowed
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751
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157
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Yes
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TOL - 5 (0.7)
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TOL - 11 (1.5) ERCD - 4 (2.5)
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Symptomatic UR: TOL - 0 maternal deaths, 2 fetal deaths (classical incision 3 prior CD, fundal incision), 0 hysterectomies
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Martin 198317
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1 or more LTCD or LVCD allowed, no rupture occurred in the 76 with prior vertical scars
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162
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555
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Yes
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TOL - 1 failed (0.6) ERCD - 2 (0.4)
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TOL - 1 successful, 3 failed (2.5) ERCD - 4 (0.7)
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Symptomatic UR: TOL - 0 maternal or fetal deaths ERCD - 0 maternal or perinatal deaths, 0 hysterectomies
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Meier 198219
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1 or more LTCD allowed, no "obvious CPD" allowed
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207
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62
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Not reported
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Not reported
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TOL - 1 (0.48) ERCD -1 (1.6)
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Symptomatic UR: TOL - 0 maternal and fetal deaths
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McMahon 19961
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1 LTCD allowed; not clear what was done with unclassified scars
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3249
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2889
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Not reported
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TOL - 10 (0.3) ERCD - 1 (0.03)
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Not reported
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TOL - 0 maternal deaths, 2 perinatal deaths, 2 hysterectomies; ERCD - 0 maternal or perinatal deaths, 0 hysterectomies
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CPD=cephalopelvic disproportion; ERCD=elective repeat caesarean delivery; LTCD=low transverse caesarean delivery; LVCD=low vertical caesarean delivery; TOL=trial of labour; UR=uterine rupture.
* Called dehiscence but symptomatic.
One third still had thin layer of peritoneum over scar.
Included in Phelan 198721