We appreciate Ms Cohain’s interest in our manuscript and concerns regarding the association between oxytocin use and uterine rupture. Unfortunately, oxytocin use was only one obstetric covariate and not our main focus. In addition, the facts presented in Ms Cohain’s letter are incorrect; 4 women with primary uterine rupture were neither induced nor received oxytocin augmentation. The claim that “the unscarred uterus that is not artificially forced to contract, will not contract so hard as to explode itself ” should not, as the majority of situations in medicine and in obstetrics, be considered absolute. We speculate that underlying undiagnosed connective tissue aberrations or genetic factors may have influenced the development of uterine rupture in these 4 women. Unfortunately, our study design precludes an investigation of causation
