American Journal of Obstetrics & Gynecology
Volume 199, Issue 1 , Pages 30.e1-30.e5, July 2008

Prediction of uterine rupture associated with attempted vaginal birth after cesarean delivery

  • William A. Grobman, MD, MBA

      Affiliations

    • Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
    • Corresponding Author InformationReprints: William A. Grobman, MD, MBA, 333 East Superior St, Suite 410, Chicago, IL 60611.
    • ,
  • Yinglei Lai, PhD

      Affiliations

    • Biostatistics Center, George Washington University, Washington, DC
    • ,
  • Mark B. Landon, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH
    • ,
  • Catherine Y. Spong, MD

      Affiliations

    • National Institute of Child Health and Human Development, Bethesda, MD
    • ,
  • Kenneth J. Leveno, MD

      Affiliations

    • Departments of Obstetrics and Gynecology at the University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • Dwight J. Rouse, MD, MSPH

      Affiliations

    • University of Alabama at Birmingham, Birmingham, AL
    • ,
  • Michael W. Varner, MD

      Affiliations

    • University of Chicago, Chicago, IL
    • ,
  • Atef H. Moawad, MD

      Affiliations

    • University of Utah, Salt Lake City, UT
    • ,
  • Steve N. Caritis, MD

      Affiliations

    • University of Pittsburgh, Pittsburgh, PA
    • ,
  • Margaret Harper, MD

      Affiliations

    • Wake Forest University, Winston-Salem, NC
    • ,
  • Ronald J. Wapner, MD

      Affiliations

    • Thomas Jefferson University, Philadelphia, PA
    • ,
  • Yoram Sorokin, MD

      Affiliations

    • Wayne State University, Detroit, MI
    • ,
  • Menachem Miodovnik, MD

      Affiliations

    • University of Cincinnati, Cincinnati, OH, and Columbia University, New York, NY
    • ,
  • Marshall Carpenter, MD

      Affiliations

    • Brown University, Providence, RI
    • ,
  • Mary J. O'Sullivan, MD

      Affiliations

    • University of Miami, Miami, FL
    • ,
  • Baha M. Sibai, MD

      Affiliations

    • University of Tennessee, Memphis, TN
    • ,
  • Oded Langer, MD

      Affiliations

    • University of Texas at San Antonio, San Antonio, TX
    • ,
  • John M. Thorp, MD

      Affiliations

    • University of North Carolina, Chapel Hill, NC
    • ,
  • Susan M. Ramin, MD

      Affiliations

    • University of Texas at Houston, Houston, TX
    • ,
  • Brian M. Mercer, MD

      Affiliations

    • Case Western Reserve University, Cleveland, OH.
    • ,
  • National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

Received 5 October 2007; accepted 17 March 2008. published online 28 April 2008.

Objective

The purpose of this study was to develop a model that predicts individual-specific risk of uterine rupture during an attempted vaginal birth after cesarean delivery.

Study Design

Women with 1 previous low-transverse cesarean delivery who underwent a trial of labor with a term singleton were identified in a concurrently collected database of deliveries that occurred at 19 academic centers during a 4-year period. We analyzed different classification techniques in an effort to develop an accurate prediction model for uterine rupture.

Results

Of the 11,855 women who were available for analysis, 83 women (0.7%) had had a uterine rupture. The optimal final prediction model, which was based on a logistic regression, included 2 variables: any previous vaginal delivery (odds ratio, 0.44; 95% CI, 0.27-0.71) and induction of labor (odds ratio, 1.73; 95% CI, 1.11-2.69). This model, with a c-statistic of 0.627, had poor discriminating ability and did not allow the determination of a clinically useful estimate of the probability of uterine rupture for an individual patient.

Conclusion

Factors that were available before or at admission for delivery cannot be used to predict accurately the relatively small proportion of women at term who will experience a uterine rupture during an attempted vaginal birth after cesarean delivery.

Key words: prediction, uterine rupture, vaginal birth after cesarean delivery

 

 Supported by grants from the National Institute of Child Health and Human Development (HD21410, HD21414, HD27860, HD27861, HD27869, HD27905, HD27915, HD27917, HD34116, HD34122, HD34136, HD34208, HD34210, HD40500, HD40485, HD40544, HD40545, HD40560, HD40512, and HD36801).

 Cite this article as: Grobman WA, Lai Y, Landon MB, et al. Prediction of uterine rupture associated with attempted vaginal birth after cesarean delivery. Am J Obstet Gynecol 2008;199:30.e1-30.e5.

PII: S0002-9378(08)00310-4

doi:10.1016/j.ajog.2008.03.039

American Journal of Obstetrics & Gynecology
Volume 199, Issue 1 , Pages 30.e1-30.e5, July 2008