Cesarean delivery complicated with peripartum infection increases the
risk of uterine rupture during subsequent trial of labour: A
retrospective case-control study
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.