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OBJECTIVE: The purpose of this study was to identify the risk factors associated with overt, catastrophic uterine rupture and to report maternal and neonatal outcomes. The associated elapsed time window for delivery of an uncompromised neonate was also investigated. STUDY DESIGN: A retrospective study with review of charts and monitor strips was performed. RESULTS: Between Jan. 1, 1983, and June 30, 1992, there were 106 cases of uterine rupture at our institution. Of these, seven charts were incomplete and excluded; of the remainder, 28 patients had complete, 13 patients had partial, and 58 patients had no fetal extrusion into the maternal abdomen. Maternal characteristics or intrapartum events were not predictive of the catastrophic extent of uterine rupture. There was one maternal death. Complete fetal extrusion was associated with a higher incidence of perinatal mortality and morbidity. Significant neonatal morbidity occurred when ≥18 minutes elapsed between the onset of prolonged deceleration and delivery. CONCLUSION: Neonatal and maternal complications in uterine rupture with complete fetal extrusion were low with prompt intervention.

OBJECTIVE: The purpose of our study was to thoroughly investigate the risk factors of uterine rupture in patients undergoing trial of labor after cesarean section. STUDY DESIGN: We conducted a case-control study of 70 patients with prior cesarean delivery with uterine rupture during trial of labor between January 1983 and June 1990. The risk factors of uterine rupture were identified, and the estimates of the relative risks were reported. RESULTS: The risk of uterine rupture was increased in patients who had an excessive amount of oxytocin, who had exeprienced dysfunctional labor, and who had a history of two or more cesarean deliveries. Epidural anesthesia, macrosomia, history of successful vaginal delivery after cesarean section, unknown uterine scar, and history of cesarean delivery because of cephalopelvic disproportion were not associated with uterine rupture. CONCLUSIONS: We recommend that all patients with a history of cesarean delivery be observed closely for progression of labor. Recognition of an active-phase arrest disorder, despite adequate augmentation with oxytocin, requires operative delivery.