Pregnancy After Uterine Rupture: An Analysis of Obstetric Outcomes [ID 1759]

INTRODUCTION: Uterine rupture recurrence rate is estimated to be as high as 42% in subsequent pregnancies. To prevent recurrence, the American College of Obstetricians and Gynecologists recommends planning cesarean delivery at 36 0/7 to 37 0/7 weeks. Given the rarity of this obstetrical emergency, particularly one followed by subsequent pregnancy, management is guided by expert opinion. We aim to review outcomes in subsequent pregnancies to optimize management going forward. METHODS: This is a retrospective review of uterine rupture cases identified at a large county hospital between 2009 and 2023. Patients who underwent hysterectomy or sterilization at time of rupture were excluded. For patients who experienced a subsequent pregnancy and delivery, demographics and outcomes were collected via the electronic medical record. RESULTS: There were 89 cases of uterine rupture with an overall rate of 5.0 ruptures per 10,000 births. Of the 44 patients who were not sterilized, 12 achieved subsequent pregnancy. The average gestational age at delivery was 35 5/7 weeks. Five patients (42%) underwent scheduled cesarean at an average of 37 6/7 weeks of gestation. Six (50%) presented in labor and one (8%) with prelabor rupture of membranes at an average of 34 2/7 weeks of gestation. Four of these patients delivered prior to 36 weeks. Four of the five scheduled cesareans were uncomplicated, and the fifth was complicated by placenta accreta spectrum requiring planned hysterectomy. No cases of recurrent uterine rupture were identified. CONCLUSIONS/IMPLICATIONS: Recurrent uterine rupture is rare. Preterm labor was common in subsequent pregnancies, with half laboring prior to planned delivery, and one-fourth laboring prior to 36 weeks. These findings favor an earlier delivery in patients with a history of uterine rupture.