Labor induction and augmentation post cesarean delivery: Birth order and the risk of uterine rupture

Hila Hochler, Tamar Wainstock, Michal Lipschuetz, Eyal Sheiner, Yossef Ezra, Simcha Yagel, Asnat Walfisch

Research output: Contribution to journalMeeting Abstract


Previous cesarean delivery (CD) is a substantial risk factor for subsequent uterine rupture. Data is inconsistent regarding grandmultiparity (GMP, ≥6th delivery) and the risk for uterine rupture. Specifically, no data exists regarding the risk associated with labor induction or augmentation in GMP women post CD

Study Design
We conducted a retrospective multicenter study including all trials of labor following one previous CD (TOLAC) between the years 2003-2015 in three tertiary hospitals. We included singleton deliveries at ≥24 weeks with vertex presentation.

The study group comprised of GMP with one previous CD who underwent labor induction or augmentation. There were two control groups: 1) Multiparous (MP) women (2-5th delivery) post CD undergoing labor induction/augmentation, and 2) GMP post CD without labor induction/augmentation.

The primary outcome was uterine rupture. Secondary outcomes included obstetrical and perinatal complications.

The study population included 8,227 TOLACs. In both GMP groups mean maternal age was higher as compared to the MP group (p<0.0001), and prolonged second stage of labor rates were lower (p<0.0001).

The study group included 564 TOLACs of GMP women, 435 of which underwent labor induction and 129 underwent augmentation. No cases of uterine rupture were documented in the study group. In the MP control group, which included 1,958 TOLACs with induction/augmentation, 5 cases of uterine rupture were documented (0.3%). The second control group (GMP with no intervention) included 5,755 TOLACs with 15 uterine rupture cases (0.3%). No significant difference in uterine rupture rates was noted between the three TOLAC groups (p=0.480)

There were no cases of intrapartum death (IPD) in the study group. The incidence of IPD in either control groups was 0.1% (p=0.799).

CD rate was higher when induction or augmentation were applied, both in the GMP group (36%) and in the MP group (39.7%), as compared to 24.2% in the GMP group with no such intervention (p<0.0001). There was no difference in the rates of other obstetrical and perinatal complications (Table)

Previous CD and labor induction and augmentation are established risk factors for uterine rupture. Grandmultiparity does not increase the risk beyond that of labor induction or augmentation during TOLAC
Original languageEnglish GB
Pages (from-to)S508-S508
JournalAmerican Journal of Obstetrics and Gynecology
Issue number1
StatePublished - Jan 2019


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