Objective
We sought to estimate the risk of uterine rupture associated with labor induction
in women attempting trial of labor after cesarean (TOLAC) accounting for length of
labor.
Study Design
This was a nested case-control study of women attempting TOLAC within a multicenter
retrospective cohort study of women with a prior cesarean. Time-to-event analyses
were performed with time zero defined as the first cervical exam of 4 cm. Subjects
experienced the event (uterine rupture) or were censored (delivered).
Results
In all, 111 cases of uterine rupture were compared to 607 controls. When accounting
for length of labor, the risk of uterine rupture in induced labor was similar to the
risk in spontaneous-onset labor (hazard ratio, 1.52; 95% confidence interval, 0.97–2.36).
An initial unfavorable cervical exam was associated with an increased risk of uterine
rupture compared to spontaneous (hazard ratio, 4.09; 95% confidence interval, 1.82–9.17).
Conclusion
After accounting for labor duration, induction is not associated with an increased
risk of uterine rupture in women undergoing TOLAC.
Key words
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Article Info
Publication History
Published online: September 26, 2011
Accepted:
September 20,
2011
Received in revised form:
July 29,
2011
Received:
April 13,
2011
Footnotes
This work was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) ( R01HD35631 , G.A.M.). L.M.H. is supported by a grant from NICHD ( T32HD055172 ; principal investigator, G.A.M.) and National Institutes of Health/National Center for Research Resources ( UL1RR024992 ; principal investigator, Bradley Evanoff, MD, MPH).
The authors report no conflict of interest.
Reprints not available from the authors.
Cite this article as: Harper LM, Cahill AG, Boslaugh S, et al. Association of induction of labor and uterine rupture in women attempting vaginal birth after cesarean: a survival analysis. Am J Obstet Gynecol 2012;206:51.e1-5.
Identification
Copyright
© 2012 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
