[Rupture of the uterus as a complication in delivery after cesarean section]

In present clinical practice there is an increasing number of patients with delivery with previous cesarean section which is frequent reason for the repeated one. The most serious complication in labour with previous cesarean section is the rupture of the uterus which is as frequent in labour by natural way as in repeated cesarean section. This is a reason that many of obstetricians do not support attitude "Once cesarean section, always a cesarean".

In a retrospective study in five years period beginning January 1, 1998, we analyzed total number of deliveries, total number of cesarean section, way of deliveries with previous cesarean section and frequency of complications.

We used Chi2 test and Contigency table.

In analyzed period from January 1, 1998 through December 31, 2002, we completed 24,194 deliveries at Ob/Gyn Clinic in Tuzla. Out of this number we performed 4073 cesarean sections or 16.83%. Out of 24,194 deliveries we had 1328 (5.49% of all deliveries) deliveries after performed cesarean in previous pregnancy. Out of 1328 deliveries following cesarean we completed by natural way 323 pregnancies or 24.33% and by repeated cesarean 1005 or 75.67%. Previous one cesarean had 1191, previous two cesarean 126, and previous three cesarean had 11 women. Out of 1328 deliveries by previous cesarean we had 12 (0.90%) or 1:111 cases, complicated by intrapartum rupture of the uterus. It was significantly more than in group of deliveries by unscarred uterus (1:16,849 deliveries). Three of 12 ruptures of the uterus were in group by natural way of delivery and 9 cases in group by repeated cesarean, no statistical difference (p>0.05). Out of 12 cases complicated by rupture of the uterus, ten cases were incomplete and two complete rupture of the uterus.

Repeated cesarean section by his complications imposes the careful choice of indication for primary cesarean section and by this way make maternal mortality and morbidity significantly lower, specially in the light of the fact that only 24.33% deliveries following cesarean is completed vaginally. The most frequent complication was rupture of the uterus in relation 1:111 deliveries.