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When the studies were limited to a subset of 8 that provided data about the spontaneous rupture of unscarred uteri in developed countries, the rate was 1 per 8,434 pregnancies (0.012%).Congenital uterine anomalies, multiparity, previous uterine myomectomy, the number and type of previous cesarean deliveries, fetal macrosomia, labor induction, uterine instrumentation, and uterine trauma all increase the risk of uterine rupture, whereas previous successful vaginal delivery and a prolonged interpregnancy interval after a previous cesarean delivery may confer relative protection.Despite the apparent increase in the risk of uterine rupture associated with high parity, Gardeil et al found only 2 women with uterine rupture among 39,529 multigravidas who had no previous uterine scar (0.005%).

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The peer-reviewed literature was searched using the Pub Med, Medline, and Cochrane databases for all relevant articles published in the English language.

Nineteen occurred during labor (86%), and 3 occurred before labor (14%).

This percentage was markedly different from that of gravidas with a previous uterine scar, for whom the timing of uterine rupture between labor and the antepartum period was nearly evenly distributed.

Despite this, many investigations concerning the use of oxytocin and the risk of uterine rupture have failed to make this distinction.

Based on this type of limited information, the increased risk of uterine rupture attributable to the use of oxytocin in gravidas with unscarred uteri is uncertain.

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