Pregnancy Complications After Prior Uterine Surgery: Much Ado About Little?

Classic obstetric teaching calls for concern about uterine rupture in laboring women with prior uterine surgeries outside the lower uterine segment (e.g., myomectomy, classic cesarean delivery); however, these fears are largely theoretical rather than evidence-based. Investigators from the NIH-sponsored Maternal-Fetal Medicine Units Network reviewed outcomes of >13,000 deliveries to women with prior uterine surgery to determine risk for obstetric complications associated with either previous myomectomy or classic cesarean delivery versus low transverse cesarean delivery.

Of 176 patients with prior myomectomies, none experienced uterine rupture (95% confidence interval, 0%–1.98%). Risk for rupture was 0.88% in 455 women with prior classical c…