Editorials

Vaginal delivery after caesarean section

BMJ 2004; 329 doi: http://dx.doi.org/10.1136/bmj.329.7462.359 (Published 12 August 2004) Cite this as: BMJ 2004;329:359
  1. Jeanne-Marie Guise ([email protected]), associate professor
  1. Oregon Health and Science University Department of Obstetrics and Gynecology, UHN-50, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA

    Determining thresholds for risks requires more than uterine rupture rates

    Once considered unthinkable, vaginal delivery after a previous caesarean section remains a safe option for many women. One of the greatest concerns for patients, providers, hospitals, and policy makers with regard to vaginal delivery after prior caesarean is the potential for devastating consequences such as perinatal death from uterine rupture. Although the risk factors associated with uterine rupture have been investigated often, few studies have attempted to measure mortality and morbidity directly related to uterine rupture, and none has examined whether outcomes related to uterine rupture are related to the number of births per year in the hospital. This editorial discusses the current evidence regarding risk factors for catastrophic uterine rupture and possible preventive measures, and considers the importance of framing risk in policy, and discussions between provider and patient.

    Uterine rupture remains a rare event

    In this issue Smith et al present population based data from the Scottish birth registry, confirming that uterine rupture is a rare event, occurring in 3.5 per 1000 trials of labour.1 A recent systematic review of studies found a rate of 2.7/1000 trials of labour.2 …

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