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Poster Session 4

(1088) Trends in uterine rupture and perinatal outcome among individuals undertaking trial of labor after cesarean

Friday, January 31, 2025
4:00 PM – 6:00 PM  
Objective: ACOG endorses trial of labor after cesarean (TOLAC) as a reasonable alternative to repeat cesarean delivery (CD). Concordantly, national rates of TOLAC have increased but the risk of uterine rupture remains a serious complication. We aimed to evaluate U.S. trends in uterine rupture and perinatal outcomes among individuals undertaking TOLAC from 2010 to 2022.

Study Design: This was a population-level retrospective cohort study using natality files in the National Vital Statistics System (NVSS) from 2010-2022. We included individuals with singleton, cephalic, term pregnancies undertaking TOLAC with 1 or 2 prior CD. The primary outcome was uterine rupture. Secondary outcomes included unplanned hysterectomy, blood transfusion, maternal or neonatal ICU admission, and neonatal death. Baseline characteristics were compared among those with and without uterine rupture. Temporal trends in outcomes were characterized using JoinPoint regression with average annual percentage change (AAPC) and 95% CI reported. Log binomial modeling estimated changes in maternal outcomes by 1-year increments adjusting for confounding.

Results: Of 1,016,073 deliveries included, uterine rupture occurred in 2,888 (0.28%). Those with uterine rupture were more likely to be older, have gestational diabetes, and be diagnosed with a hypertensive disorder of pregnancy. Rates of uterine rupture, transfusion, and maternal and neonatal ICU admission increased over time, while rates of hysterectomy were not significantly different over time and rates of neonatal death declined (Figure). In adjusted modeling, each 1-year increment remained significantly associated with higher rates of uterine rupture, transfusion, and admission to ICU but absolute rates remained low (Table).

Conclusion: While national rates of uterine rupture increased over time, uterine rupture continues to be rare. Counseling regarding mode of delivery among those with a prior CD should continue to weigh maternal and neonatal outcomes.