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Cesarean delivery complicated with peripartum infection increases the risk of uterine rupture during subsequent trial of labour: A retrospective case-control study
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  • Rina Tamir Yaniv,
  • Sivan Farladansky-Gershnabel,
  • Hadar Gluska,
  • Yair Daykan,
  • Gil Shechter Maor,
  • Ron Schonman,
  • Tal Biron-Shental
Rina Tamir Yaniv
Meir Medical Center, Kfar Saba, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv

Corresponding Author:[email protected]

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Sivan Farladansky-Gershnabel
Meir Medical Center
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Hadar Gluska
Meir Medical Center
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Yair Daykan
Meir medical center
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Gil Shechter Maor
Meir Medical Center
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Ron Schonman
Meir Medical Centre
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Tal Biron-Shental
Meir Medical Center
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Abstract

Objective: To evaluate the relation between peripartum infection at first caesarean delivery to uterine dehiscence or rupture at the subsequent delivery. Design: Retrospective case-control study from March 2014 to October 2020. Setting: University-affiliated medical centre. Sample: Women with a prior caesarean delivery and proven dehiscence or uterine rupture diagnosed during their subsequent delivery. The control group included women who had a successful vaginal birth after Cesarean section without evidence of dehiscence or uterine rupture. Methods: We compared the rate of peripartum infection during the first Cesarean delivery and other relevant variables, between the two groups. We also analysed the type of infection correlated with uterine rupture or dehiscence. Main Outcome Measures: Rate of peripartum infection. Results: A total of 168 women were included, 71 with uterine rupture or dehiscence and 97 with successful vaginal birth after Cesarean section as the control group. The rate of peripartum infection at the first caesarean delivery was significantly higher in the study group compared to the control group (22.2% vs. 8.2%, p=0.013). Multivariate logistic regression analysis found that peripartum infection remained an independent risk-factor for uterine rupture at the subsequent trial of labour after Cesarean delivery (95% CI, P=0.018). We also found that endometritis had the highest correlation to uterine rupture (9.8% vs. 0%, p=0.02) Conclusion: Peripartum infection in the first caesarean delivery, may be an independent risk-factor for uterine rupture in a subsequent delivery. Compared to other infections, endometritis may pose the greatest risk for uterine rupture or dehiscence.