[Uterine rupture: prediction, diagnosis et management]

To evaluate predictors of uterine rupture (UR) after previous cesarean birth. To define the diagnosic criteria of UR, management and prognosis of subsequent pregnancies.

Analysis of Medline database(®), Cochrane Library Database(®) and international guidelines.

Uterine rupture is a serious complication both for mother (mortality<1 %, severe morbidity 15 %) and child (mortality at term 3-6%, perinatal asphyxia 6-15%), occurring in 0,2 to 0,8 % of trial of labour after cesarean (TOLAC). The individual risk for UR after TOLAC is multifactorial and predictive scores showed no clinical utility in routine (grade B). The risk of UR is decreased in case of previous vaginal delivery and increased in case of classical C-section, previous UR, induction of labour (especially using prostaglandins), more than one previous caesarean section, fetal macrosomia and interval less than 6 months before the next pregnancy. Monitoring of labor, including intrauterine pressure catheters, do not allow to anticipate the diagnosis. This one relies on a combination of severe pathologic patterns of FHM with unusual pelvic pain. Suspected UR requires expedited laparotomy (consensus opinion). A subsequent pregnancy is not contraindicated, but the risk of recurrent UR is high and a repeat cesarean section is then recommended (grade B).