Caesarean section (CS) is increasing globally, and women with prior CS are at higher risk of uterine rupture in subsequent pregnancies. However, little is known about the incidence, risk factors, and outcomes of uterine rupture in women with prior CS, especially in developing countries. To investigate this, we conducted a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health, which included data on delivery from 359 facilities in 29 countries. The incidence of uterine rupture among women with at least one prior CS was 0.5% (170/37,366), ranging from 0.2% in high-Human Development Index (HDI) countries to 1.0% in low-HDI countries. Factors significantly associated with uterine rupture included giving birth in medium-or low-HDI countries (adjusted odds ratio [AOR] 2.0 and 3.88, respectively), lower maternal educational level (<= 6 years) (AOR 1.71), spontaneous onset of labour (AOR 1.62), and gestational age at birth < 37 weeks (AOR 3.52). Women with uterine rupture had significantly higher risk of maternal death (AOR 4.45) and perinatal death (AOR 33.34). Women with prior CS, especially in resource-limited settings, are facing higher risk of uterine rupture and subsequent adverse outcomes. Further studies are needed for prevention/management strategies in these settings.UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP)World Health Organization (WHO)United States Agency for International Development (USAID)Ministry of Health, Labour and Welfare of JapanGynuity Health ProjectsJapan Agency for Medical Research and Development, AMEDNatl Res Inst Child Hlth & Dev, Dept Allergy & Clin Immunol, Tokyo, JapanUniv Tsukuba, Dept Global Hlth Nursing, Fac Med, Tsukuba, Ibaraki, JapanNatl Ctr Child Hlth & Dev, Dept Educ Clin Res, Tokyo, JapanSt Lukes Int Univ, Grad Sch Nursing Sci, Global Hlth Nursing, Tokyo, JapanWHO, UNDP UNFPA UNICEF WHO World Bank Special Programm, Dept Reprod Hlth & Res, Geneva, SwitzerlandUniv Fed Sao Paulo, Evidence Based Healthcare Postgrad Programme, Dept Internal Med, Sao Paulo, BrazilMinist Hlth, Family Hlth Bur, Maternal & Child Morbid & Mortal Unit, Colombo, Sri LankaSora No Mori Clin, Yaese, Okinawa, JapanFortis Mem Res Inst, Obstet & Gynecol, Gurgaon, IndiaNatl Ctr Dis Prevent & Control, Dept Hlth, Manila, PhilippinesKochi Univ, Kochi Med Sch, Dept Pediat, Kochi, JapanUniv Abdou Moumouni Niamey, Niamey, NigerAmer Univ Beirut, Beirut, LebanonUniv Nairobi, Obstet & Gynaecol, Sch Med, Nairobi, KenyaUniv Sao Paulo, Ribeirao Preto Med Sch, Dept Social Med, Sao Paulo, BrazilNatl Ctr Child Hlth & Dev, Dept Hlth Policy, Tokyo, JapanUniv Fed Sao Paulo, Evidence Based Healthcare Postgrad Programme, Dept Internal Med, Sao Paulo, BrazilWeb of Scienc
