Periviable Cesarean Delivery: A Risky Proposition

Allison Bryant, MD, MPH reviewing Lannon S et al. Obstet Gynecol 2015.

Risk for uterine rupture after periviable cesarean delivery is high, regardless of incision type.

The risk for uterine rupture after cesarean delivery is well known, and it is clear that this risk is higher after vertical uterine (“classical”) incisions. However, risk for uterine rupture after very early cesarean delivery is less well delineated. Investigators used registry data from Washington State to determine the likelihood of uterine rupture after cesarean deliveries at 20 to 26 weeks' gestation (i.e., periviable) compared with those at term.

Among almost 11,000 women from 1989 through 2008, 4% had periviable cesarean deliveries and the rest had term cesarean deliveries. Classical incisions were performed in 36% of periviable deliveries and in <1% of term deliveries. Women who delivered at 20 to 26 weeks' gestation were 5 times as likely to experience uterine rupture in their next delivery compared with women who delivered at term (1.8% vs. 0.4%; P<0.001), with substantial accompanying morbidity. This difference persisted even among women with low transverse incisions at their first delivery, and even accounting for labor induction or augmentation at the second delivery.

Citation(s):

Lannon S et al. Uterine rupture risk after periviable cesarean delivery. Obstet Gynecol 2015; 125:1095.