The consequences of previous uterine scar dehiscence and cesarean delivery on subsequent births

Objective: To determine whether women with a previous uterine scar dehiscence are at increased risk of adverse perinatal outcomes in the following delivery. Methods: A retrospective cohort study was conducted of all subsequent singleton cesarean deliveries performed at the Soroka University Medical Center, Beer-Sheva, Israel, between January 1, 1988, and December 31, 2011. Clinical and demographic characteristics, maternal obstetric complications, and fetal complications were evaluated among women with or without a previous documented uterine scar dehiscence. Results: Of the 5635 pregnancies associated with at least two previous cesarean deliveries, 180 (3.2%) occurred among women with a previous uterine scar dehiscence. Women with this condition in a prior pregnancy were more likely than those without previous uterine scar dehiscence to experience subsequent preterm delivery (86[47.8%] vs 1350 [24.7%]; P < 0.001), low birth weight (47 [26.1%] vs 861 [15.8%]; P < 0.001), and peripartum hysterectomy (5 [2.8%] vs 20 [0.4%]; P < 0.001). Nevertheless, previous uterine scar dehiscence did not increase the risk of uterine rupture, placenta accreta, or adverse perinatal outcomes, such as low Apgar scores at 5 minutes and perinatal mortality. Conclusion: Uterine scar dehiscence in a previous pregnancy is a potential risk factor for preterm delivery, low birth weight, and peripartum hysterectomy in the following pregnancy. (C) 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.