Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section

doi:10.1136/bmj.329.7456.19

BMJ 2004;329:19 (3 July), doi:10.1136/bmj.329.7456.19

Paper

Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section

Jeanne-Marie Guise, assistant professor¹, Marian S McDonagh, assistant professor², Patricia Osterweil, research assistant², Peggy Nygren, senior research associate², Benjamin K S Chan, senior research associate², Mark Helfand, director²

¹ Department of Obstetrics and Gynecology, Oregon Health & Science University, UHN-50, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA, ² Evidence-based Practice Center, Oregon Health & Science University

Correspondence to: J-M Guise guisej{at}ohsu.edu

Objective To evaluate the incidence and consequences of uterinerupture in women who have had a delivery by caesarean section.

Design Systematic review.

Data sources Medline, HealthSTAR, Cochrane Database of SystematicReviews, Cochrane Controlled Trials Register, National Centrefor Reviews and Dissemination, reference lists, and nationalexperts. Studies in all languages were eligible if publishedin full.

Review methods Methodological quality was evaluated for eachstudy by using criteria from the United States Preventive ServicesTask Force and the National Health Service Centre for Reviewsand Dissemination. Uterine rupture was categorised as asymptomaticor symptomatic.

Results We reviewed 568 full text articles to identify 71 potentiallyeligible studies, 21 of which were rated at least fair in quality.Compared with elective repeat caesarean delivery, trial of labourincreased the risk of uterine rupture by 2.7 (95% confidenceinterval 0.73 to 4.73) per 1000 cases. No maternal deaths wererelated to rupture. For women attempting vaginal delivery, theadditional risk of perinatal death from rupture of a uterinescar was 1.4 (0 to 9.8) per 10 000 and the additional risk ofhysterectomy was 3.4 (0 to 12.6) per 10 000. The rates of asymptomaticuterine rupture in trial of labour and elective repeat caesareandid not differ significantly.

Conclusions Although the literature on uterine rupture is impreciseand inconsistent, existing studies indicate that 370 (213 to1370) elective caesarean deliveries would need to be performedto prevent one symptomatic uterine rupture.

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