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Updated: May 20, 2026

Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
The pattern of labor preceding uterine rupture
Lorie M Harper1, Alison G Cahill, Kimberly A Roehl
1Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
Objective:
We sought to characterize the labor of women attempting trial of labor after cesarean (TOLAC) who experience uterine rupture.
Study Design:
We conducted a secondary analysis of a nested case-control study of women attempting TOLAC. Women experiencing uterine rupture (cases) were compared to 2 reference groups: successful TOLAC and failed TOLAC. Interval-censored regression was used to estimate the median time to progress 1 cm in dilation and the total time from 4-10 cm.
Results:
A total of 115 cases were compared to 341 successful TOLAC and 120 failed TOLAC. The time to progress 1 cm was similar between groups until 7-cm dilation. After 7 cm, cases of uterine rupture required longer to progress than successful TOLAC (median [95th percentile] time from 7-8 cm: 0.38 [1.91] vs 0.16 [0.79] hours; from 8-9 cm: 0.28 [1.10] vs 0.10 [0.39] hours). Women with a uterine rupture had labor curves similar to those with a failed TOLAC.
Conclusion:
Women with labor dystocia in the active phase of labor should be closely monitored for uterine rupture in TOLAC.
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