LAUSR

We want to congratulate Tsz‐Kin Lo for raising this important point. Indeed, we found vacuum-assisted vaginal birth after Cesarean (VA‐VBAC) was an independent factor for adverse maternal outcome including uterine rupture in 0.4% 3/679 cases [1] as compared with primigravid women. As in the cases reported by Lo., all cases in our study were diagnosed in the postpartum period. Uterine rupture is a rare complication on that may be associated with significant maternal and fetal mortality. A previous uterine scar, especially from a previous cesarean section, is the most common predisposing factor and is estimated at 0.5% in these women [2]. In our recent study [3], we reported 29 cases (of overall 143, 20.3%) of intrapartum uterine rupture which were diagnosed following a vaginal delivery, during the early postpartum period while in 15/29 (51.7%) women, the rupture was diagnosed following vacuum-assisted vaginal birth, mostly due to non‐reassuring fetal heart rate (14/15, 93%). Therefore, we agree with this author’s comment that uterine rupture should be suspected following the delivery of women with a history of cesarean especially in cases where a vacuum extraction was performed due to non‐reassuring fetal status. Funding This study was not funded.