Maternal outcomes:
Selected maternal outcomes as well as the mode of delivery are presented
in Table 2 . Our primary outcome – composite adverse maternal
outcome rate was similar in both groups; 6.2% of the parturients
attempting TOL vs. 4.8%of the parturients who had elective repeat CD
(p=0.2).
However, several differences were noted: rates of uterine rupture were
lower among those who had elective repeat CD (0.1% vs. 0.6%, p=0.04).
Overall, there were six cases of uterine rupture (0.22%) three in each
group. All three cases of uterine rupture among parturients who intended
to have an elective CD occurred before active labor, during the latent
phase. They all presented with abdominal pain prior to their scheduled
elective date and underwent surgery without delay. Among parturients
attempting TOL two out of three cases of uterine rupture occurred in the
latent phase. These parturients presented with fetal distress or
abdominal pain. One case was diagnosed unexpectedly post-partum during a
revision of the uterine cavity due to retained placenta. Hysterectomy
rate also did not differ between the groups. Hysterectomy was the
outcome of DIC following sepsis or pre-eclampsia. Only one of the cases
of hysterectomy was due to uterine rupture. A non-significant trend of
higher rates of re-laparotomy after CD was shown among those who had a
planned repeat CD. However, there were only three cases of
re-laparotomy, all of which were in the group of elective repeat CD. In
two of the cases an internal abdominal bleeding was detected and the
third was due to an eventration of the small intestine through the
Pfannenstiel incision.
There were no differences in the rates between the groups of
endometritis, PPH, hemoglobin drop≥4 gr/dL and blood products, prolonged
hospitalization, and ICU admission.