Correspondence:
Rina Tamir Yaniv
Department of Obstetrics and Gynecology
Meir Medical Center
59 Tshernichovsky St.
Kfar Saba 44281 Israel.
Email: Rina.Tamir@clalit.org.il
Tel: 0097297472209
Fax: 0097297471262
Email: Rina.Tamir@clalit.org.il
Short title: Infection at CD and subsequent uterine rupture
Word count: 2173
Objective: To evaluate the relation between peripartum infection at first caesarean delivery to uterine dehiscence or rupture at the subsequent delivery.
Design: Retrospective case-control study from March 2014 to October 2020.
Setting: University-affiliated medical centre.
Sample: Women with a prior caesarean delivery and proven dehiscence or uterine rupture diagnosed during their subsequent delivery. The control group included women who had a successful vaginal birth after Cesarean section without evidence of dehiscence or uterine rupture.
Methods : We compared the rate of peripartum infection during the first Cesarean delivery and other relevant variables, between the two groups. We also analysed the type of infection correlated with uterine rupture or dehiscence.
Main Outcome Measures : Rate of peripartum infection.
Results : A total of 168 women were included, 71 with uterine rupture or dehiscence and 97 with successful vaginal birth after Cesarean section as the control group. The rate of peripartum infection at the first caesarean delivery was significantly higher in the study group compared to the control group (22.2% vs. 8.2%, p=0.013). Multivariate logistic regression analysis found that peripartum infection remained an independent risk-factor for uterine rupture at the subsequent trial of labour after Cesarean delivery (95% CI, P=0.018). We also found that endometritis had the highest correlation to uterine rupture (9.8% vs. 0%, p=0.02)
Conclusion : Peripartum infection in the first caesarean delivery, may be an independent risk-factor for uterine rupture in a subsequent delivery. Compared to other infections, endometritis may pose the greatest risk for uterine rupture or dehiscence.
Tweetable abstract: Peripartum infection in first caesarean delivery may be a risk-factor for subsequent uterine rupture
Key words: Cesarean section; dehiscence; endometritis; infection; postpartum fever; risk-factor; TOLAC; VBAC
Funding: This study was not funded.