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Operative Obstetrics

Poster Session 4

(1139) Risk factors of uterine rupture in individuals attempting TOLAC in the setting of stillbirth

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: TOLAC counseling is based on the risk and benefits gathered from multiple cohort studies. However, the evidence may not apply in the setting of stillbirth when perinatal outcome is not considered in the evaluation, and the available data is limited. Our study aimed to assess risk factors for uterine rupture in individuals who attempted TOLAC in the setting of stillbirth.

Study Design: This was a case-control study using Fetal Death Data from the National Vital Statistics System from 2014 to 2021. We limited analysis to individuals with stillbirth at 20 weeks or greater and a history of cesarean delivery and those who underwent TOLAC. Variables were compared between individuals who had uterine rupture and those who did not using bivariate analysis. Those with P-value < 0.1 were included in multivariable logistic regression to calculate adjusted odds ratios (aOR) with 95th confidence intervals (95% CI).

Results: Of 11,550 eligible for inclusion, 147 (1.3%) had uterine rupture. Compared to individuals who did not have uterine rupture, those who had uterine rupture were less likely to be Hispanic, deliver at term, and have greater number of prior cesarean delivery. Risk factors for uterine rupture included greater gestational age (20-23 weeks 0.5% [referent]; 24-27 weeks 0.6% [aOR 1.19, 95%CI 0.57-2.49]; 28-36 weeks 1.4% [aOR 2.78, 95%CI 1.71-4.51]; 37 weeks or greater 3.7% [aOR 8.12, 95%CI 5.00-13.18]), pregestational diabetes (2.2% [aOR 1.73, 95%CI 1.03-2.91]), and number of cesarean delivery (1 previous cesarean 1% [referent]; 2 previous 2.1% [aOR 2.68, 95%CI 1.87-3.84]; 3 previous 2.0% [aOR 2.58, 95%CI 1.51-4.42]). Hispanic compared to non-Hispanic ethnicity was associated with decreased odds of uterine rupture (0.9% vs. 1.4% [aOR 0.57, 95%CI 0.36-0.92]).

Conclusion: Overall, the rate of uterine rupture in individuals who attempted TOLAC in the setting of stillbirth was comparable to overall historical data, even in the setting of multiple cesarean deliveries. Individuals considering the mode of delivery after stillbirth at term should be counseled on a potentially increased odds of uterine rupture.