Clinical significance of uterine scar dehiscence in women with previous cesarean delivery: prevalence and independent risk factors.

Objective: To determine the prevalence and risk factors for uterine scar dehiscence in women following cesarean delivery (CD).

Study Design: Our computerized database was used to identify patients with recurrent CDs in the index pregnancy (1988-2002). Women with uterine dehiscence were compared to those without dehiscence. Multiple logistic regression analysis was used to determine independent risk factors for dehiscence.

Results: Of 7,833 women with at least 1 previous CD and a CD in the index pregnancy, 81 (1.03%) had uterine scar dehiscence. This finding was associated with nonprogress of labor during the first stage, number of previous CDs, parity, preterm delivery and low Apgar scores at 5 minutes. For patients with only 1 previous CD, failure to progress during the first stage of labor and lower parity were associated with uterine scar dehiscence. The numbers of previous CDs, gravidity and placenta previa rate were significantly higher in the group with dehiscence who delivered preterm.

Conclusion: Preterm delivery, nonprogress of labor during the first stage and number of previous CDs were found to be independent risk factors for uterine scar dehiscence. In contrast, parity had a protective effect against dehiscence.