Monday, October 29, 2007

uterine rupture with VBAC

I've been doing a lot of uterine rupture research these days. I'll post on it sometime. Here's some food for thought posted on Sage Femme's blog.

uterine rupture with VBAC
This was sent to me recently by someone online. I remember reading this somewhere a couple years ago (maybe more?) but I cannot find who wrote it. Anyone?
Ruptures are also more common than dying in a plane crash. Henci Goer's review of the literature on VBACs found 46 ruptures in 15,154 labors. This equates to a 0.3% rate... or 1 in 333, if you prefer.

Your annual risk of dying in a plane crash is 1 in 4000, according to one source, and 1 in 700,000 according to another. I can't explain the massive discrepancy between the two figures, except to quote Mark Twain about "lies, damn lies, and statistics."

Since you asked, here are some more probability statistics for you:

Your risk of dying in a car accident, over the course of your lifetime, is between 1 in 42 and 1 in 75. This is roughly 4 to 5 times greater than the risk of uterine rupture.

You're about twice as likely to have your car stolen (that's an annual risk) than to experience a uterine rupture.

Your odds of being murdered are 1 in 140 over the course of your lifetime. That's 2 times more likely than the risk of rupture.

The annual risk of having a heart attack is 1 in 160, 2 times more likely than rupture.

Your risk of dying from heart disease is roughly 1 in 6, or 55 times greater than your risk of rupture.

If you're a smoker, your risk of dying from lung cancer is 1 and a half times more likely than a VBAC mom rupturing during her labor.

You're about 17 times more likely to contract an STD this year than you are to have a uterine rupture; more likely to contract gonorrhea than to rupture, as well.

You're 13 times more likely to get food poisoning than to rupture.

You're more likely to have twins than a uterine rupture. Odds of twins: 1 in 90. That's about 3 1/2 times the likelihood of rupture.

If you ride horseback, you're 3 times more likely to die in a riding accident than you are to experience a uterine rupture.

If you ride a bike on the street, you are 4 times more likely to die in an accident (annual risk) than you are to suffer a rupture.

Having a serious fire in your home during the next year is twice as likely as experiencing a rupture.

You're ten times as likely to win at roulette as you are to have a uterine rupture.

If you flip a coin, you'll be more likely to get heads (or tails) 8 times in a row than to rupture.

The risk of cord prolapse is 1 in 37 (2.7%), or nearly ten times more likely than that of rupture.

And a final irony (heads up, those of you who want a doc to give his/her opinion on your likelihood of rupture next pregnancy!)...You're 6 times more likely to have a doctor who is an impostor than you are to suffer a rupture. Two percent of docs are phonies (1 in 50), according to several sources I found.

So instead of worrying about rupture, why not take a few minutes to check up on your doctor's credentials? ;) It'd be a more profitable use of your time, and a substantially more likely cause for alarm.


Anonymous said...

Very interesting!! Are the stats for uterine rupture in general, or for uterine rupture for VBAC specifically?

tired of smiling said...

The chance of uterine rupture was taken from Henci Goer's book "The Thinking Woman's Guide to a Better Birth" (highly recommended, by the way). Page 284.
"Basing my calculations on 37,000 labours after cesarean reported in twenty-nine studies, I calculated that 4 per 1,000 women experience scar problems during or after labor. The scar giving way resulted in neurological injury or the baby's death in 4 per 10,000 labours overall, versus 3 per 10,000 in the 14,700 planned cesarians reported in eleven of those twenty-nine studies."
So, short answer is that the stats are for VBAC labours only.

tired of smiling said...

For the record:
I think I must have a different version of the book, as my stats are a little different than what was quoted. In the original post from Sage femme it was 46 ruptures in 15,154 labours and my book has 37,000 labours, so I bet it's just a case of a different edition of the book, with more research in it. Anyhow, the stats are very close, so I don't think it contradicts.

Jessica said...

These are very different stats than in your post, 3 per 10,000 vs. 46 ruptures in 15,154 labors.

Although 14,700 sounds like a big sample size, when the results are 3 per 10,000, this sample size actually seems pretty small.

All very interesting!

tired of smiling said...

Based on the stats here, the rupture rate is either .3% (46 in 15,154) or .4% (4 in 1,000**). What's changed is the sample size. (**if I had the book here I would look it up, the sample size was actually 37,000 - so by my math it would have been 148 ruptures in 37,000 labours).

The point is that it is quite rare, and I think the sample size is large enough to draw that conclusion. The author actually analyzed 29 different studies and added the results together to get this number.

The other number that is confusing the issue is the 4 per 10,000 - this is the number that resulted in neurological damage or death - .04%, by my math (You were always better at that than me.)