Uterine rupture risk during trial of labor after one cesarean in a population-based cohort study of induction method and labor management

A prior cesarean section is the primary risk factor for uterine rupture in a trial of labor after cesarean, a rare event associated with severe maternal and neonatal morbidity and mortality. This population-based cohort study aimed to determine the risk of uterine rupture in women undergoing trial of labor after one previous cesarean section in the Stockholm-Gotland Region and to examine associations between induction methods, labor management, and rupture risk. The cohort included 11,947 women with a cephalic-presenting, singleton infant at ≥ 37 + 0/6 weeks of gestation. Incidence of uterine rupture was calculated by labor onset and management strategies. Multivariable logistic regression assessed associations between labor characteristics, uterine rupture, and adverse maternal and perinatal outcomes. Overall, 216 (1.8%) women experienced uterine rupture. Induction of labor was associated with higher odds of rupture than spontaneous onset (aOR 1.63; 95% CI 1.20–2.22). Prostaglandin induction showed 2.6-fold increased odds (aOR 2.58; 95% CI 1.77–3.74), while balloon catheter showed no association (aOR 0.99; 95% CI 0.61–1.61). Prostaglandin use was thus linked to increased risk of uterine rupture, whereas balloon catheter induction was not. When induction is necessary, mechanical methods may be safer, though vigilant monitoring remains crucial.