The Association between the Indication for Previous Cesarean Delivery and the risk for Uterine Rupture in TOLAC: A Retrospective Cohort Study

Objective To determine whether the indication for a previous cesarean delivery is associated with the risk of uterine rupture among women undergoing a trial of labor after cesarean (TOLAC). Design Retrospective cohort study. Setting Single university-affiliated tertiary medical center. Population or Sample Women with a singleton pregnancy at ≥24 weeks’ gestation, one prior low-transverse cesarean delivery, and an attempted TOLAC between 2012 and 2024. Methods Previous cesarean delivery indications were categorized as antepartum indications, suspected fetal distress, first-stage dystocia, or second-stage dystocia. Cases of uterine dehiscence were excluded. Multivariable logistic regression was used to evaluate the association between prior cesarean indication and uterine rupture, adjusting for relevant maternal and intrapartum factors. Main Outcome Measures Complete uterine rupture. Results Among 147,045 deliveries, 7,340 women underwent TOLAC, of whom 91 (1.2%) experienced uterine rupture. A previous cesarean delivery performed for second-stage dystocia was significantly more common among women with uterine rupture than among those without rupture (12.1% vs 3.2%, p