Will our results help in counseling mothers with previous
uterine ruptures?
As the outcomes of new pregnancies were favorable, this may reassure
women with previous ruptures, but the most challenging issue in
counseling and planning is the timing of the CS. This study included
different periods of time with different management approaches. In
addition, there was no written consensus on the optimal timing of
delivery in our national guidelines in previous years. Therefore, the
data are not appropriate for answering this question. One can see that
the timing of delivery was evaluated on an individual basis and mostly
affected by the presence or absence of perinatal deaths at previous
ruptures.
This factor increased fear among both obstetricians and mothers, leading
to iatrogenic premature delivery. These data may guide us to better and
more objective timing of delivery. There must be a balance between risk
of prematurity and risk of new complete uterine rupture. Admission in
the last weeks, close to 37-38 weeks, may be a solution. In Netherland11, there was assessment of lung maturity or
administration of corticosteroid if CS was planned before 37 weeks.
There was no administration of corticosteroids in our women who
delivered by planned CS from 34 weeks. This might be something to
consider in the future, especially in those less than 36 weeks, reducing
complication of respiratory distress.
Our study showed that the risk for women with previous rupture was not
only of repeat complete rupture, but also of placenta accreta and
hysterectomy. Placenta accreta is known to increase with increasing
number of scars15 or CS performed
preterm.16 Women with previous ruptures should be
counseled about this, especially if their rupture occurred at an earlier
gestational age or they have multiple uterine scars.
No perinatal death occurred in the last period of the study, indicating
a better prognosis for mothers with previous rupture. A study regarding
the outcome of pregnancy after previous uterine rupture in recent years
would be worthwhile.