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Risk factors for uterine rupture after a previous cesarean birth

Risk factors for uterine rupture after a previous cesarean birth
Major risk factors
Previous uterine rupture
Previous hysterotomy that involved the upper uterus (eg, classical incision, high vertical incision, inverted T or J incision)
Modest and uncertain risk factors
Labor, induction, cervical ripening with prostaglandins*
Increasing maternal age
Birth weight >4000 grams
Interdelivery interval less than approximately 18 months (and particularly <6 months)
More than one previous cesarean birth
Gestational age ≥41 weeks
Factors that decrease the risk of rupture
A prior vaginal birth, either before or after the prior cesarean birth, significantly reduces, but does not eliminate, the risk of uterine rupture.[1]
For additional information refer to UpToDate content on induction and cervical ripening in patients with a previous cesarean birth and on choosing the route of delivery after cesarean birth.
* Data on mechanical methods of cervical ripening in patients with a prior cesarean birth are limited by small sample size and retrospective analysis. These data are generally reassuring, but uterine ruptures have occurred, as they have occurred during labors in most other settings.
Reference:
  1. Guise JM, Eden K, Emeis C, et al. Vaginal birth after cesarean: New insights. Evid Rep Technol Assess (Full Rep) 2010; 191:1.
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