Uterine Rupture Trends in Patients Pursuing Trial of Labor After Cesarean in the United States from 2010 to 2022.

Abstract

National rates of trial of labor after cesarean (TOLAC) have increased, but the risk of uterine rupture remains. Clinical practice- and patient-level changes also have occurred in the past decade, and an evaluation of contemporary uterine rupture rates is needed. Using natality files available in the National Vital Statistics System from 2010 to 2022, we conducted a repeated cross-sectional analysis to evaluate U.S. trends in uterine rupture and perinatal outcomes among individuals undertaking TOLAC. Temporal trends were characterized using joinpoint regression, with average annual percent change (AAPC) and 95% CI reported. There were 2,888 uterine ruptures (0.28%) among 1,016,073 included deliveries. The rate of uterine rupture increased over time, from 0.20% in 2010 to 0.37% in 2022 (AAPC 6.2, 95% CI, 4.3-8.7). Although rates of uterine rupture increased over time, it remains a rare event with a low absolute risk.