Rupture of previous cesarean section scar

Abstract AR

Objectives : To determine the incidence of rupture of previous cesarean section scar in our hospital and to analyze these cases in order to determine avoidable risk factors.

Methods : A 2-year prospective study of all patients with previous cesarean section admitted from January 1, 1991 to December 31, 1993 was conducted.

Results ; Rupture of previous cesarean section scar was diagnosed in 15 of 1764 cases giving an incidence of 0.85%.

In 13 cases the rupture was of a lower segment scar and in 2 of an upper segment scar.

There were 3 patients with more than 1 previous cesarean section.

Eight patients had a parity>4.

Only 4 of the cases had received antenatal care.

Oxytocin was given to 6 of the cases.

In 7 of the cases, the previous scar had been followed by an uncomplicated vaginal birth.

Complete uterine rupture was diagnosed in 9 of the cases and of these 9, 2 were with a previous classical scar.

Repair of the rupture was performed in 14 of the cases with an additional bilateral tubal ligation in 2.

Subtotal hysterectomy was performed in 1 case with an upper segment scar rupture.

There were 7 stillbirths, 1 of these at 22-24 weeks of gestation.

The indication for operative intervention was antepartum hemorrhage in 4, postpartum hemorrhage in 2, fetal distress in 2, and miscellaneous causes in 7 including failed vacuum delivery, abnormal abdominal shape, obstructed labor, or receding presenting part.

Conclusion :Rupture of previous caesarian scar was not common in our experience.

The rupture was associated with lack of antenatal care, residence outside Benghazi, high parity, and lack of transport facilities.

Oxytocin should be used with extreme caution and under close supervision.