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Severe maternal and perinatal outcomes from uterine rupture among women at term with a trial of labor



To describe maternal and perinatal morbidity and mortality associated with uterine rupture (UR) among women with prior cesarean/s, singleton term pregnancies and a trial of labor after cesarean (TOLAC).

Study Design:

Linked hospital discharge files and birth/fetal death certificates identified potential cases of UR in Massachusetts from 1990 to 1998 with definitive identification by medical record abstraction.


Among the 347 identified URs, severe outcomes occurred in 86 cases (25%), in 49 (14%) of mothers and 49 (14%) of infants. Of the infants, 25 were discharged with a good prognosis. Maternal age and interdelivery interval <18 months (relative risk (RR)=1.55; 95% confidence interval (CI): 1.05, 2.31) were associated with a severe outcome. The type of hospital and labor were not associated with the increased risk of a severe outcome.


Assuming a 0.7% UR rate among women at term with a TOLAC, the increased rate of severe outcomes related to UR above the baseline risk of elective cesarean is estimated to be 1.3 per 1000 TOLACs.

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This study was funded in part by Cooperative Agreement #S1012-19/19 between the Centers for Disease Control and Prevention, the Association of Schools of Public Health and the Boston University School of Public Health. We thank members of the MMMRC members and staff for their important contribution to this study, and Drs Elizabeth Brown, neonatologist, and Gary Krauss, Ob-Gyn, who assisted in the assessments of relatedness of outcomes, and Timothy Heeren, PhD, for statistical consultation.

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Correspondence to S Ringer.

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Barger, M., Nannini, A., Weiss, J. et al. Severe maternal and perinatal outcomes from uterine rupture among women at term with a trial of labor. J Perinatol 32, 837–843 (2012).

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  • uterine rupture
  • trial of labor
  • vaginal birth after cesarean
  • maternal outcomes
  • neonatal outcomes

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