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Both grandmultiparity (≥5 prior deliveries) and trial of labor after cesarean (TOLAC) are risk factors for uterine rupture. To determine whether these are synergistic factors, investigators reviewed birth records from three hospitals in Jerusalem from 1999 through 2009 and identified 1922 deliveries to women in their sixth or higher-order labor who had one previous lower segment transverse cesarean delivery. The primary endpoint was uterine rupture, but other obstetric complications (e.g., labor induction, shoulder dystocia) were also noted.
Six cases of uterine rupture (0.3%) occurred, two of which ended in hysterectomy. The four additional hysterectomies were not related to uterine rupture. Emergency cesarean delivery was performed in 12.7…