Document Detail

Optimal timing and mode of delivery after cesarean with previous classical incision or myomectomy: a review of the data.
MedLine Citation:
PMID:  21962624     Owner:  NLM     Status:  In-Data-Review    
Uterine rupture is an obstetrical emergency that can be catastrophic for the mother and fetus. Previous uterine surgery, including previous cesarean delivery or myomectomy, is an established risk factor, although the exact magnitude of the associated risk remains uncertain. We reviewed the literature related to uterine rupture after previous cesarean delivery with classical incision or myomectomy in an attempt to quantify outcomes associated with various management strategies. Although cesarean delivery with a classical incision is relatively uncommon (representing 0.3%-0.4% of deliveries), it presents a significant risk of rupture in subsequent pregnancies (1%-12% on the basis of published reports). Available data suggest that scheduled cesarean at 36-37 weeks optimizes both maternal and fetal outcomes in these cases. Patients with previous myomectomy are more frequently encountered in the obstetrical population. The risk of uterine rupture in subsequent pregnancies in these women is substantially lower than those with a history of previous classical incision (0.5%-0.7% on the basis of published reports). Although less common, given the potentially devastating consequences of uterine rupture, scheduled delivery at 38 weeks is suggested in those women requiring cesarean delivery. Despite the lack of well-controlled studies, preferred management strategies can be gleaned from previously published data to optimize maternal and fetal outcomes in women with these risk factors.
Mark B Landon; Courtney D Lynch
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Seminars in perinatology     Volume:  35     ISSN:  1558-075X     ISO Abbreviation:  Semin. Perinatol.     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-03     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7801132     Medline TA:  Semin Perinatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  257-61     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Richard L. Meiling-Professor and Chairman, The Ohio State University College of Medicine, Columbus, OH.
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