Will our results help in counseling mothers with previous uterine ruptures?
As the outcomes of new pregnancies were favorable, this may reassure women with previous ruptures, but the most challenging issue in counseling and planning is the timing of the CS. This study included different periods of time with different management approaches. In addition, there was no written consensus on the optimal timing of delivery in our national guidelines in previous years. Therefore, the data are not appropriate for answering this question. One can see that the timing of delivery was evaluated on an individual basis and mostly affected by the presence or absence of perinatal deaths at previous ruptures. This factor increased fear among both obstetricians and mothers, leading to iatrogenic premature delivery. These data may guide us to better and more objective timing of delivery. There must be a balance between risk of prematurity and risk of new complete uterine rupture. Admission in the last weeks, close to 37-38 weeks, may be a solution. In Netherland11, there was assessment of lung maturity or administration of corticosteroid if CS was planned before 37 weeks. There was no administration of corticosteroids in our women who delivered by planned CS from 34 weeks. This might be something to consider in the future, especially in those less than 36 weeks, reducing complication of respiratory distress.
Our study showed that the risk for women with previous rupture was not only of repeat complete rupture, but also of placenta accreta and hysterectomy. Placenta accreta is known to increase with increasing number of scars15 or CS performed preterm.16 Women with previous ruptures should be counseled about this, especially if their rupture occurred at an earlier gestational age or they have multiple uterine scars.
No perinatal death occurred in the last period of the study, indicating a better prognosis for mothers with previous rupture. A study regarding the outcome of pregnancy after previous uterine rupture in recent years would be worthwhile.