Pregnancy in Women with a History of Uterine Rupture

Importance With increased rates of primary and repeat cesarean deliveries, the potential for uterine rupture and management of women with a history of uterine rupture has also increased. Taking care of a pregnant woman with a prior uterine rupture requires understanding of the risks, the need for additional surveillance, and the limitations of our knowledge about how rupture affects subsequent pregnancies. Objective The aims of this study were to review the literature on pregnancy after uterine rupture and to summarize the evidence to help the obstetrician care for a pregnant woman with a history of uterine rupture. Evidence Acquisition Evidence for this review was acquired using PubMed. Conclusions Pregnancy after uterine rupture carries a risk of spontaneous repeat rupture before the onset of labor and of repeat rupture during early labor. Elective cesarean delivery before the onset of labor is the safest strategy to prevent maternal and neonatal morbidity and mortality. However, more research is needed to better inform risk estimates and to guide management of pregnant women with a history of uterine rupture. Relevance Obstetricians will increasingly be caring for women who have experienced uterine rupture and subsequently become pregnant. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After participating in this activity, the learner should be better able to summarize the evidence regarding risk of spontaneous recurrent rupture and of recurrent rupture in labor in women pregnant after a prior uterine rupture; formulate an evidence-based plan for the care of a patient pregnant after a prior uterine rupture; and recognize factors that may modify the risk of rupture recurrence and interpret the evidence regarding their interaction with risk.