Chance of uterine rupture after 2 c-sections

[Georgetown HB Mom]

Does anyone know the chance of a uterine rupture after 2 c-sections. I can only find the percent for one prior c-section.

Thanks,
Lisa

[briome]

http://vbacfacts.com/2008/10/30/comp...ple-variables/

I don't know if you want this info for you to feel better or a family member but it is a lot more complicated then just a percentage. Don't them them induce or augment you and rupture is A LOT less likely.
Please read-http://vbacfacts.com/vbac/
" There are a few things to consider in terms of VBAC – type of scar, labor induction, and types of uterine rupture. VBACs have historically received a bad rap because of the methods of incision that were originally used for cesarean sections, such as the classical and inverted T, have higher rates of rupture than the low transverse (bikini cut) method. 40% of births in American are induced and women who have been induced or have had their labor augmented through the use of drugs to stimulate contractions and ripen the cervix, experience an increased risk of rupture including women who have unscarred uteri. Studies that measure the rate of uterine rupture rarely distinguish between true uterine rupture and uterine dehiscence which gives the medical community and public at large an inflated, inaccurate estimate of risk."


http://vbacfacts.com/2008/02/26/esti...erine-rupture/

[TCA2008]

statistically speaking, it is no different than after 1 c-section. But the risks of a 3rd cesarean are FAR higher than a first or second cesarean.

http://medicalcenter.osu.edu/patient...press/?ID=2835

[Pirogi]

Originally Posted by TCA2008

statistically speaking, it is no different than after 1 c-section. But the risks of a 3rd cesarean are FAR higher than a first or second cesarean.

http://medicalcenter.osu.edu/patient...press/?ID=2835

This link doesn't work.

[Georgetown HB Mom]

Originally Posted by briome

http://vbacfacts.com/2008/10/30/comp...ple-variables/

I don't know if you want this info for you to feel better or a family member but it is a lot more complicated then just a percentage. Don't them them induce or augment you and rupture is A LOT less likely.
Please read-http://vbacfacts.com/vbac/
" There are a few things to consider in terms of VBAC – type of scar, labor induction, and types of uterine rupture. VBACs have historically received a bad rap because of the methods of incision that were originally used for cesarean sections, such as the classical and inverted T, have higher rates of rupture than the low transverse (bikini cut) method. 40% of births in American are induced and women who have been induced or have had their labor augmented through the use of drugs to stimulate contractions and ripen the cervix, experience an increased risk of rupture including women who have unscarred uteri. Studies that measure the rate of uterine rupture rarely distinguish between true uterine rupture and uterine dehiscence which gives the medical community and public at large an inflated, inaccurate estimate of risk."


http://vbacfacts.com/2008/02/26/esti...erine-rupture/

Thank you for the information. A friend was asking about it. I am pregnant with my 3rd but I homebirth and have never had a c-section. She is also pregnant with her 3rd and has two prior c-sections. She desperately wants a vbac and her doctor is avoiding the subject. She is now looking into homebirth and asked if I knew about risk of rupture after 2 c-sections.

Thank you,
Lisa

[babycatcher12]

Originally Posted by TCA2008

statistically speaking, it is no different than after 1 c-section. But the risks of a 3rd cesarean are FAR higher than a first or second cesarean.

http://medicalcenter.osu.edu/patient...press/?ID=2835

That's not entirely true. I have been extensively researching the risks of a VBA3C as I'm planning a HBA3C.

There have been several studies that show that VBAMC are either just as safe or only slightly (this included VBA2C) higher than moms with only one scar.

"Miller (1994) had 1,827 TOLs in women with 2 or more cesareans. Of these, there were 241 TOLs in women with 3 or more prior cesareans (VBA3+Cs). Overall, the rupture rate was found to be 1.7% in all VBAMCs combined; 1.8% in VBA2Cs, but only 1.2% in VBA3+Cs."

[CoBabyMaker]

I think that TCA2008 was trying to explain that the risk of a 3rd C/S is higher than that of the previous sections, not that VBAMC was higher risk.

[TCA2008]

http://medicalcenter.osu.edu/viewer/...px?newsid=2835

Here is the article stating that based on the largest study ever conducted regarding VBACs, the uterine rupture rate for a single prior cesarean is .7 percent, and for a woman with mutliple prior cesareans, the rupture rate is .9 percent - the difference is not statistically significant - in other words, you have about the same chance of a rupture (less than 1%) whether you've had one or more than one cesarean.

However, the major medical complication risk resulting from having a third cesarean performed are FAR higher than for the second c-section - this is statistically significant.
Here are just a few of the major risks of a third cesarean:

Delivery-Related Hysterectomy
The chances of needing an emergency hysterectomy go up with the number of c-sections. While the risk of a hysterectomy is only 0.42 percent during a second c-section, it jumps to 2.41 percent after the fourth c-section and to 8.99 percent after a sixth, according to the study by Silver, Landon, et al.

Increased Bleeding and Difficult Delivery
In the July 2006 issue of Obstetrics and Gynecology, as study by Nisenblat, Barak et al compared women who had two c-sections with those having three. Excessive blood loss occurred in 3.3 percent of women with two c-sections but went up to 7.9 percent with a third cesarean delivery. Difficult delivery went from 0.2 percent to 5.1 percent. They found that any major complication, including placenta previa and placenta accreta, occurred in 4.3 percent of those having a second c-section and rose to 8.7 percent for a third.

copied from:
http://www.livestrong.com/article/31...complications/

http://www.ncbi.nlm.nih.gov/pubmed/16738145

[babycatcher12]

I think that TCA2008 was trying to explain that the risk of a 3rd C/S is higher than that of the previous sections, not that VBAMC was higher risk

You're right! I can't read today. I wonder if pregnancy brain counts for the eyes too?

My apologies TCA2008. I'm an idiot. I agree! The risks of a 3rd c/s are much more significant! Not to mention that research shows babies born by c/s are more likely to develop Leukemia, asthma and Diabetes.

[Storm Bride]

Yes - after three, risks start to climb. Complications in future pregnancies, particularly placental issues (previa and accreta) take a big jump after either the fourth or fifth (I don't have the numbers in front of me at the moment). Somehow, these numbers are never mentioned during discussions abou the dangers of VBAC and VBAmC.

[mum4boys]

Originally Posted by Storm Bride

Yes - after three, risks start to climb. Complications in future pregnancies, particularly placental issues (previa and accreta) take a big jump after either the fourth or fifth (I don't have the numbers in front of me at the moment). Somehow, these numbers are never mentioned during discussions abou the dangers of VBAC and VBAmC.

But how accurate are those numbers since the population is so small of woman attemting a VBAC for their 4th or 5th.?

[Drummer's Wife]

Originally Posted by mum4boys

But how accurate are those numbers since the population is so small of woman attemting a VBAC for their 4th or 5th.?

There definitely are less women to study, for sure, b/c c-sections aside, most women don't have more than 3 kids, yk? But I think the findings are based on the fact that each subsequent pregnancy means the placenta needs to find a new place to attach - and with a prior section, the chances of it making it's home over the scar or blocking the cervix are just higher.

That all said, I really do wish there were more studies done on vba3/4/5c vs. a 4th/5th/6th c-section. It's hard to make a decision, personal medical history aside, b/c there just isn't a ton of information out there.

Even though I ended up with 4 c-sections, and have been TTC #5 for quite a while, I came to the conclusion that for me a 5th c-section is more risky than a vba4c. Not that I would have much luck finding a provider to take me on - home or hospital - but based on the research and soul searching I did, this was where I ended up (and who knows, I could learn something else in the future that changed my mind completely).

[Storm Bride]

Originally Posted by mum4boys

But how accurate are those numbers since the population is so small of woman attemting a VBAC for their 4th or 5th.?

There aren't a lot of numbers. But, honestly, if a woman is planning to have a fair number of kids, the numbers that do exist indicate that VBAmC is safer than having multiple sections. At least, that's my take. One thing that's often overlooked about this whole issue is that the risk/benefit analysis is very complicated. People need to balance so many factors re: minor, but common, complications vs. major, but rare, complications, and complications in future pregnancies vs. risk in this pregnancy and so many factors. It's not straightforward.

I got hit by the bad side of the odds...and I still think VBAC is generally safer.

[Cian'sMama]

I just met with the head of obstetrics at a major hospital who told me that the risk of uterine rupture after 2 prior cesareans was .7%. This is approximately two times the rate for one prior cesarean. This statement was on par with what I had learned in my research.

The most recent research I had read was from the NIH conference in March 2010. The conference report stated the following:

A recent meta-analysis revealed that two or more previous cesarean deliveries were associated with higher rupture rates than one prior cesarean
delivery (1,590 per 100,000 compared to 560 per 100,000).

You can find the information at

http://consensus.nih.gov/2010/images..._statement.pdf

If the link doesn't work let me know.

Hope that helps and good luck!

[AustinMom]

Originally Posted by Cian'sMama

I just met with the head of obstetrics at a major hospital who told me that the risk of uterine rupture after 2 prior cesareans was .7%. This is approximately two times the rate for one prior cesarean. This statement was on par with what I had learned in my research.

The most recent research I had read was from the NIH conference in March 2010. The conference report stated the following:

A recent meta-analysis revealed that two or more previous cesarean deliveries were associated with higher rupture rates than one prior cesarean
delivery (1,590 per 100,000 compared to 560 per 100,000).

You can find the information at

http://consensus.nih.gov/2010/images..._statement.pdf

If the link doesn't work let me know.

Hope that helps and good luck!

The info they have on VBAMC and uterine rupture is rated low grade evidence, so personally, I don't think it's enough to go by. Also, they include inductions and augmentations in the study they had.