Maternal and fetal morbidity associated with uterine rupture of the unscarred uterus

We read with interest the article by Gibbins et al., in which they discussed 20 women with uterine rupture, none of whom had previous cesarean deliveries, but all of whom had either pitocin induction or augmentation or both. The authors dismissed pitocin as a cause of the uterine rupture, saying that “Although women with primary rupture were more likely to undergo labor induction and/or oxytocin augmentation during labor, these latter differences likely reflect differences in provider management among women with a scarred uterus.” This is the common mistake called “the error of small numbers” for which, among other things, Kahneman won the Nobel Prize.

Behavioral economics teaches us that uterine rupture among women without a previous cesarean delivery is a rare finding for which significant findings cannot be drawn by comparing their rates of labor induction and augmentation with induction and/or augmentation rates for women with previous cesarean scars. The significant finding is that not a single woman with an unscarred uterus experienced uterine rupture in the absence of labor induction and/or augmentation. The same exact finding was repeated in another recent study on the same subject. “The previously untraumatized, spontaneously laboring uterus will not persist in contracting so vigorously as to destroy itself”, as Williams Obstetrics has taught for generations. Not a single case of a uterine rupture in a previous unmanipulated uterus (including dilation and curettage, Shirodkar, etc) has ever been documented in the absence of induction or augmentation. It is important and even potentially lifesaving to underline the fact that a woman with an unscarred uterus can be 100% sure of avoiding uterine rupture if they avoid medical induction and augmentation.

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May 4, 2017 | Posted by in GYNECOLOGY | Comments Off on Maternal and fetal morbidity associated with uterine rupture of the unscarred uterus
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