Some researchers fear that there is more case of rupture of the uterus during the natural childbirth at the women having undergone a Caesarean already, essentially because of the growing number of this type of intervention.
This complication. rare, but serious. would touch nine women on 1 000 (close to 1%) among those that deliver a second child naturally after having had their first by Caesarean. At those not having had a Caesarean, this risk is only of 0,18 on 1 000.
These data come from a recent survey carrying on 300 200 childbirths of a second child, intervening in Sweden of 1992 to 2001.
At the time of these childbirths, 227 women underwent an uterine rupture. Among them, 14 lost their baby, what represents a death rate to the birth of 51 for 1 000. This proportion is of 1,4 for 1 000 at the women not having lived a rupture at the time of the second childbirth following a Caesarean.
According to the authors of the survey, some factors can explain why a scar on the uterus can tear itself during a the childbirth:
* the starting point of the childbirth with a medicine (E2 prostaglandine, for example); * the mother’s age (more than 35 years); * the child’s weight (more of 4 kg or 8,8 books).
To Canada, the rate of birth by Caesarean is in constant evolution: of 17% that he/it was in 1993-1994, he/it was of 26% in 2005-2006. It is less that to the United States and in Australia (29%, in 2004), but more that England (24%, in 2005-2006). The world organization of Health (WHO) recommends not to practice any Caesareans that in 15% of all accouchements2.
A risk known of the obstetricians
In February 2005, the Society of the obstetricians and gynecologists of Canada (SOGC) emitted some recommandations3 concerning the patients having undergone a Caesarean in order to avoid an uterine rupture during a subsequent childbirth.
The SOGC insists so that the physicians debate risks of a vaginal childbirth with their patients who gave birth before by Caesarean. She/it recalls however that, in most cases, ” a vaginal childbirth can be succeeded so much in all safety for the mother that for the child.”
According to the SOGC, only the fact to have had a so-called Caesarean ” classic”, with an incision to the vertical, as well as a Caesarean with an incision in the shape of ” T reversed, constitute a specific contra-indication to a vaginal childbirth. In this case, the risk of uterine rupture is from 4% to 9%, against 0,2% to 1,6% for the other types of incisions.
Nevertheless, the organism suggests to its members to recommend to the women having undergone a Caesarean already to give birth in a hospital, where a surgical intervention of emergency can be executed quickly in case of complications.
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