Can uterine rupture in patients attempting vaginal birth after cesarean delivery be predicted?
Received 10 March 2006; received in revised form 15 May 2006; accepted 10 June 2006.
Objective
This study was undertaken to use multivariable methods to develop clinical predictive models for the occurrence of uterine rupture by using both antepartum and early intrapartum factors.
Study design
This was a planned secondary analysis from a multicenter case-control study of uterine rupture among women attempting vaginal birth after cesarean (VBAC) delivery. Multivariable methods were used to develop 2 separate clinical predictive indices–one that used only prelabor factors and the other that used both prelabor and early labor factors. These indices were also assessed with the use of Receiver operating characteristic curves.
Results
We identified 134 cases of uterine rupture and 665 noncases. No single individual factor is sufficiently sensitive or specific for clinical prediction of uterine rupture. Likewise, the 2 clinical predictive indices were neither sufficiently sensitive nor specific for clinical use (receiver operating characteristic curve [area under the curve] 0.67 and 0.70, respectively).
Conclusion
Uterine rupture cannot be predicted with either individual or combinations of clinical factors. This has important clinical and medical-legal implications.
aDepartment of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
bDepartment of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia PA
Supported by a grant from NICHD (RO1 HD 35631). G.A.M. is a recipient of a K24 grant from NICHD (K24 HD01289), which partially supports this work. J.P. is a recipient of a K24 grant from NICHD (K24 HD01298), which partially supports this work.
Presented at the 26th Annual Meeting of the Society for Maternal Fetal Medicine, January 30-February 4, 2006, Miami, FL.
ABSTRACT