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Objective To assess incidence of uterine rupture in scarred and unscarred uteri and its maternal and fetal complications in a nationwide design.Design Population-based cohort study.Setting All 98 maternity units in the Netherlands. Methods Women with uterine rupture were prospectively collected using a web-based notification system. Data from all pregnant women in the Netherlands during the study period were obtained from Dutch population-based registers. Results were stratified by uterine scar.Main outcome measures Population-based incidences, severe maternal and neonatal morbidity and mortality, relative and absolute risk estimates.Results There were 210 cases of uterine rupture (5.9 per 10 000 pregnancies). Of these women, 183 (87.1%) had a uterine scar, incidences being 5.1 and 0.8 per 10 000 in women with and without uterine scar. No maternal deaths and 18 cases of perinatal death (8.7%) occurred. The overall absolute risk of uterine rupture was 1 in 1709. In univariate analysis, women with a prior caesarean, epidural anaesthesia, induction of labour (irrespective of agents used), pre-or post-term pregnancy, overweight, non-Western ethnic background and advanced age had an elevated risk of uterine rupture. The overall relative risk of induction of labour was 3.6 (95% confidence interval 2.7-4.8). ConclusionThe population-based incidence of uterine rupture in the Netherlands is comparable with other Western countries. Although much attention is paid to scar rupture associated with uterotonic agents, 13% of ruptures occurred in unscarred uteri and 72% occurred during spontaneous labour.

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In a longitudinal study of 12 healthy nulliparous women the developmental course of specific fetal movement patterns was investigated in the first half of gestation, using real-time ultrasound. The rate of occurrence of all movement patterns emerging during this period is presented. There were large differences in incidence between the various movements. In most of them a developmental trend was found, either a gradual increase in incidence as the fetus grew older (breathing movements, head rotations, jaw openings, sucking and swallowings), an increase in incidence until a plateau was reached (general movements, isolated arm movements), or an increase in incidence followed by a decrease (startles, hiccups, hand/face contacts, retroflexions of the head). In a few infrequently occurring movements no developmental trends could be observed (isolated leg movements, anteflexions of the head, yawns, stretches) whereas in some of the more frequently occurring movements a lower limit of the normal range could be defined. A few movement patterns were found to be generated at a more or less regular interval: hiccups occurred with a preference interval of one to three seconds and isolated arm movements with an interval of about 1 s. Breathing movements showed a clear developmental shift in preference interval. Between 10 and 19 weeks this changed from 2 to 3 s to less than 1 s. The majority of movements, however, seemed to occur at no regular interval or the regularity was missed because the burst length was too short. Quantification of fetal quiescence showed that in between 8 and 19 weeks total absence of movements never lasted longer than 13 min.

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