J Clin Gynecol Obstet

Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc

Journal website http://www.jcgo.org

Original Article

Volume 7, Number 2, June 2018, pages 37-42

Incidence and Risk Factors of Uterine Scar Dehiscence Identified at Elective Repeat Cesarean Delivery: A Case-Control Study

Figure 1. Flowchart of patients’ selection. CD: cesarean delivery; ERCD: elective repeat cesarean delivery; NVD: normal vaginal delivery; TOLAC: trial of labor after cesarean; USD: uterine scar dehiscence.

**Table 1.** Comparison of Maternal Characteristics Between the Study Group and the Control Group
Variable	USD (N = 27)	Control (N = 561)	P value
CD: cesarean delivery; DM: diabetes mellitus; HDP: hypertensive disorders of pregnancy; USD: uterine scar dehiscence. Continuous variables expressed as means ± standard deviation, while categorical variables expressed as numbers (percentage).
Maternal demographics
Mean maternal age (years)	28.4 ± 5.4	29 ± 5.5	0.6
Mean parity	2 ± 0.8	2.2 ± 1.5	0.52
Smoking	10 (37%)	190 (34%)	0.74
Obstetrical history
Co-morbidity
DM or HDP	3 (11.1%)	48 (8.6%)	0.65
Bateman index > 2 [8]	1 (3.7%)	59 (10.5%)	0.25
Previous preterm birth	4 (14.8%)	49 (8.9%)	0.3
Current pregnancy
Gestational age (weeks)	36.7 ± 1.8	37.6 ± 1.8	0.02
Preterm delivery < 37 weeks	9 (33.3%)	85 (15.2%)	0.012
Tertiary CD or higher	17 (63%)	219 (39%)	0.013
Inter-delivery interval ≤ 24 months	18 (66.7%)	251 (45.1%)	0.028
Twin gestation	1 (3.7%)	15 (2.7%)	0.75
Labor			0.29
Yes	14 (52%)	233 (41.6%)
No	13 (48%)	327 (58.4)
Hospital stay (days)	3.26 ± 3.6	2.5 ± 1	0.29

Table 1. Comparison of Maternal Characteristics Between the Study Group and the Control Group

Variable

USD (N = 27)

Control (N = 561)

P value

CD: cesarean delivery; DM: diabetes mellitus; HDP: hypertensive disorders of pregnancy; USD: uterine scar dehiscence. Continuous variables expressed as means ± standard deviation, while categorical variables expressed as numbers (percentage).

Maternal demographics

Mean maternal age (years)

28.4 ± 5.4

29 ± 5.5

0.6

Mean parity

2 ± 0.8

2.2 ± 1.5

0.52

Smoking

10 (37%)

190 (34%)

0.74

Obstetrical history

Co-morbidity

DM or HDP

3 (11.1%)

48 (8.6%)

0.65

Bateman index > 2 [8]

1 (3.7%)

59 (10.5%)

0.25

Previous preterm birth

4 (14.8%)

49 (8.9%)

0.3

Current pregnancy

Gestational age (weeks)

36.7 ± 1.8

37.6 ± 1.8

0.02

Preterm delivery < 37 weeks

9 (33.3%)

85 (15.2%)

0.012

Tertiary CD or higher

17 (63%)

219 (39%)

0.013

Inter-delivery interval ≤ 24 months

18 (66.7%)

251 (45.1%)

0.028

Twin gestation

1 (3.7%)

15 (2.7%)

0.75

Labor

0.29

Yes

14 (52%)

233 (41.6%)

13 (48%)

327 (58.4)

Hospital stay (days)

3.26 ± 3.6

2.5 ± 1

0.29

**Table 2.** Comparison of the Pain at the Cesarean Scar and Mode of Previous Hysterotomy Closure Between the Study Group and the Control Group
Variable	USD (N = 6)	Control (N = 202)	P value
USD: uterine scar dehiscence. Categorical variables expressed as numbers (percentage). Data were collected from Makassed General Hospital.
Pain at the cesarean scar	1 (16.7%)	20 (9.9%)	0.59
Previous hysterotomy closure			0.22
Single layer	2 (33.3%)	17/116 (14.7%)
Double layer	4 (66.7%)	99/116 (85.3%)

Table 2. Comparison of the Pain at the Cesarean Scar and Mode of Previous Hysterotomy Closure Between the Study Group and the Control Group

Variable

USD (N = 6)

Control (N = 202)

P value

USD: uterine scar dehiscence. Categorical variables expressed as numbers (percentage). Data were collected from Makassed General Hospital.

Pain at the cesarean scar

1 (16.7%)

20 (9.9%)

0.59

Previous hysterotomy closure

0.22

Single layer

2 (33.3%)

17/116 (14.7%)

Double layer

4 (66.7%)

99/116 (85.3%)

**Table 3.** Risk Factors for Uterine Scar Dehiscence
Risk factor	OR	95% CI	P value
Preterm delivery < 37 weeks	2.76	1.183 - 6.42	0.019
≥ tertiary cesarean	2.56	1.142 - 5.735	0.023
Inter-delivery interval ≤ 24 months	2.38	1.042 - 5.436	0.04

Table 3. Risk Factors for Uterine Scar Dehiscence

Risk factor

95% CI

P value

Preterm delivery < 37 weeks

2.76

1.183 - 6.42

0.019

≥ tertiary cesarean

2.56

1.142 - 5.735

0.023

Inter-delivery interval ≤ 24 months

2.38

1.042 - 5.436

0.04

**Table 4.** Comparison of Neonatal Outcomes Between the Study Group and the Control Group
Variable	USD (N = 27)	Control (N = 561)	P value
NICU: neonatal intensive care unit; USD: uterine scar dehiscence. Continuous variables expressed as means ± standard deviation and categorical variables expressed as numbers (percentage).
APGAR < 7 at 5 min	1 (3.7%)	10 (1.8%)	0.47
Asphyxia Neonatorum	1 (3.7%)	9 (1.6%)	0.41
Admission to NICU	8 (29.6%)	74 (13.2%)	0.016
Birth weight (g)	2,812 ± 505	3,040 ± 504	0.022

Table 4. Comparison of Neonatal Outcomes Between the Study Group and the Control Group

Variable

USD (N = 27)

Control (N = 561)

P value

NICU: neonatal intensive care unit; USD: uterine scar dehiscence. Continuous variables expressed as means ± standard deviation and categorical variables expressed as numbers (percentage).

APGAR < 7 at 5 min

1 (3.7%)

10 (1.8%)

0.47

Asphyxia Neonatorum

1 (3.7%)

9 (1.6%)

0.41

Admission to NICU

8 (29.6%)

74 (13.2%)

0.016

Birth weight (g)

2,812 ± 505

3,040 ± 504

0.022