Uterine Rupture After Previous Cesarean Delivery
Uterine Rupture After Previous Cesarean Delivery
Objectives: Amnioinfusion is commonly used for the intrapartum treatment of women with pregnancy complicated by thick meconium or oligohydramnios with deep variable fetal heart rate decelerations. Its benefit in women with previous cesarean deliveries is less known. Theoretically, rapid increases in intrauterine volume would lead to a higher risk of uterine rupture.
Methods: Searches of the Cochrane Library from inception to the third quarter of 2001 and MEDLINE, 1966 to November 2001, were performed by using keywords cesarean and amnioinfusion. Search terms were expanded to maximize results. All languages were included. Review articles, editorials, and data previously published in other sites were not analyzed.
Results: Four studies were retrieved having unduplicated data describing amnioinfusion in women who were attempting a trial of labor after previous cesarean section. As the studies were of disparate types, meta-analysis was not possible.
Conclusions: The use of amnioinfusion in women with previous cesarean delivery who are undergoing a trial of labor may be a safe procedure, but confirmatory large, controlled prospective studies are needed before definitive recommendations can be made.
Amnioinfusion is a proven therapy for intrapartum management of thick meconium. It has been shown to decrease the rate of subsequent cesarean section, the finding of meconium below the vocal cords, and the incidence of meconium aspiration syndrome. Its use in oligohydramnios is more debated. In women with oligohydramnios and fetal heart rate decelerations, it is of clear benefit in decreasing ominous fetal heart tracings and the need for cesarean delivery. Data regarding its use prophylactically in women without such decelerations are not as clear. Although several studies attest to a decreased risk of cesarean section, fetal acidemia, or low Apgar score, others have not shown benefit, including a recent Cochrane Review.
The use of amnioinfusion in women who have undergone previous cesarean section is less well studied. The principal concern is that rapid expansion of the intrauterine volume would lead to an increased risk of uterine rupture. This article will address that concern and evaluate the literature to date on the use of amnioinfusion in women with previous cesarean section.
Objectives: Amnioinfusion is commonly used for the intrapartum treatment of women with pregnancy complicated by thick meconium or oligohydramnios with deep variable fetal heart rate decelerations. Its benefit in women with previous cesarean deliveries is less known. Theoretically, rapid increases in intrauterine volume would lead to a higher risk of uterine rupture.
Methods: Searches of the Cochrane Library from inception to the third quarter of 2001 and MEDLINE, 1966 to November 2001, were performed by using keywords cesarean and amnioinfusion. Search terms were expanded to maximize results. All languages were included. Review articles, editorials, and data previously published in other sites were not analyzed.
Results: Four studies were retrieved having unduplicated data describing amnioinfusion in women who were attempting a trial of labor after previous cesarean section. As the studies were of disparate types, meta-analysis was not possible.
Conclusions: The use of amnioinfusion in women with previous cesarean delivery who are undergoing a trial of labor may be a safe procedure, but confirmatory large, controlled prospective studies are needed before definitive recommendations can be made.
Amnioinfusion is a proven therapy for intrapartum management of thick meconium. It has been shown to decrease the rate of subsequent cesarean section, the finding of meconium below the vocal cords, and the incidence of meconium aspiration syndrome. Its use in oligohydramnios is more debated. In women with oligohydramnios and fetal heart rate decelerations, it is of clear benefit in decreasing ominous fetal heart tracings and the need for cesarean delivery. Data regarding its use prophylactically in women without such decelerations are not as clear. Although several studies attest to a decreased risk of cesarean section, fetal acidemia, or low Apgar score, others have not shown benefit, including a recent Cochrane Review.
The use of amnioinfusion in women who have undergone previous cesarean section is less well studied. The principal concern is that rapid expansion of the intrauterine volume would lead to an increased risk of uterine rupture. This article will address that concern and evaluate the literature to date on the use of amnioinfusion in women with previous cesarean section.
