Peripartum infection at cesarean delivery may be related to uterine rupture during a subsequent trial of labor

Background: Uterine rupture or dehiscence during trial of labor after cesarean is a cause of great concern for both parturitions and physicians. Although the risk-factors for uterine rupture are well-established, surgical site infection in the first cesarian-section has not been investigated in depth. Aim: To evaluate the relation between peripartum infection after caesarean delivery to uterine dehiscence or rupture at the subsequent delivery. Methods: : A retrospective case-control study. The study group included women with a prior caesarean delivery and proven dehiscence, or uterine rupture diagnosed during their subsequent delivery. The control group were women who had a successful vaginal birth after cesarean section without evidence of dehiscence or uterine rupture. We compared the rate of infection during the cesarean delivery between the two groups. Findings: A total of 168 women were included, 71 with uterine rupture or dehiscence and 97 with successful vaginal birth after cesarean section. The rate of peripartum infection at the first caesarean delivery was significantly higher in the study group compared to the control group (22.2% vs. 8.2%,p=0.013). Endometritis had the highest correlation to uterine rupture (9.8% vs. 0%,p=0.02) Discussion: Peripartum infection in the first caesarean delivery, may be an independent risk-factor for uterine rupture in a subsequent delivery. Compared to other infections, endometritis may pose the greatest risk for uterine rupture or dehiscence. Conclusion: when consulting with a patient on repeat cesarean section vs. trial of labor after cesarian, endometritis after the previous surgery should be included among the considerations, along with other traditional risk-factors.