Risk factors for complete uterine rupture

Al-Zirqi, Iqbal; Daltveit, Anne Kjersti; Forsén, Lisa; Stray‐Pedersen, Babill; Vangen, Siri

doi:10.1016/j.ajog.2016.10.017

Cited by 111 publications

(78 citation statements)

References 18 publications

(20 reference statements)

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“…Another important finding is the clear pattern of increased odds of UR with increasing parity after controlling for covariates. Other authors have found an increase in UR with higher parity [ 3 , 7 , 9 ]. For example, a study examining risk of complete UR in Norway found women (without a previous cesarean delivery) with a parity of three or more had 2.4 greater odds of complete UR compared to women with less than three births [ 7 ].…”

Section: Discussionmentioning

confidence: 92%

“…Other authors have found an increase in UR with higher parity [ 3 , 7 , 9 ]. For example, a study examining risk of complete UR in Norway found women (without a previous cesarean delivery) with a parity of three or more had 2.4 greater odds of complete UR compared to women with less than three births [ 7 ]. Results on the influence of grand multiparity compared to lower parity (2–4 births) on UR from studies in low-income countries are mixed [ 3 ].…”

Section: Discussionmentioning

confidence: 92%

“…In high-income settings, the greatest risk factor is a scarred uterus, typically from a previous cesarean delivery. In contrast, while this association is also observed in low-income settings, risk for UR in these contexts appears largely related to factors such as parity, obstructed labor, induction of labor, use of prostaglandins, and/or breech presentation [ 2 , 3 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of uterine rupture in a large sample of women in Senegal and Mali: cross-sectional analysis of QUARITE trial data

Delafield

Pirkle

Dumont

2018

BMC Pregnancy Childbirth

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BackgroundThe purpose of this study was to investigate predictors of uterine rupture in a large sample of sub-Saharan African women. Uterine rupture is rare in high-income countries, but it is more common in low-income settings where health systems are often under-resourced. However, understanding of risk factors contributing to uterine rupture in such settings is limited due to small sample sizes and research rarely considers system and individual-level factors concomitantly.MethodsCross-sectional data analysis from the pre-intervention period (Oct. 1, 2007- Oct. 1, 2008) of the QUARITE trial, a large-scale maternal mortality study. This research examines uterine rupture among 84,924 women who delivered in one of 46 referral hospitals in Mali and Senegal. A mixed-effects logistic regression model identified individual and geographical risk factors associated with uterine rupture, accounting for clustering by hospital.ResultsFive hundred sixty-nine incidences of uterine rupture (0.67% of sample) were recorded. Predictors of uterine rupture: grand multiparity defined as > 5 live births (aOR = 7.57, 95%CI; 5.19–11.03), prior cesarean (aOR = 2.02, 95%CI; 1.61–2.54), resides outside hospital region (aOR = 1.90, 95%CI: 1.28–2.81), no prenatal care visits (aOR = 1.80, 95%CI; 1.44–2.25), and birth weight of > 3600 g (aOR = 1.61, 95%CI; 1.30–1.98). Women who were referred and who had an obstructed labor had much higher odds of uterine rupture compared to those who experienced neither (aOR: 46.25, 95%CI; 32.90–65.02).ConclusionsThe results of this large study confirm that the referral system, particularly for women with obstructed labor and increasing parity, is a main determinant of uterine rupture in this context. Improving labor and delivery management at each level of the health system and communication between health care facilities should be a priority to reduce uterine rupture.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2064-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Predictors of uterine rupture in a large sample of women in Senegal and Mali: cross-sectional analysis of QUARITE trial data

Delafield

Pirkle

Dumont

2018

BMC Pregnancy Childbirth

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“…Vaginal delivery is recommended in all but the most unusual cases of stillbirth, where clinical indications exist or because of the preference of the patient [ 12 , 18 ]. Caesarean section is associated with short and long-term maternal morbidity, including an increased possibility of uterine rupture in future induced births [ 44 – 46 ], and fetal mortality in future pregnancies [ 47 ]. For births ≥ 26 weeks gestation, the study found an overall caesarean rate of 22.9%.…”

Section: Discussionmentioning

confidence: 99%

Care quality following intrauterine death in Spanish hospitals: results from an online survey

Cassidy

2018

BMC Pregnancy Childbirth

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BackgroundThe objective of the study was to evaluate practices in Spanish hospitals after intrauterine death in terms of medical/ technical care and bereavement support care.MethodsA cross-sectional descriptive study using an online self-completion questionnaire. The population was defined as women who had experienced an intrauterine fetal death between sixteen weeks and birth, either through spontaneous late miscarriage/stillbirth or termination of pregnancy for medical reasons. Respondents were recruited through an online advertisement on a stillbirth charity website and social media. The analysis used Pearson’s chi-squared (p ≤ 0.05) test of independence to cross-analyse for associations between objective measures of care quality and independent variables.ResultsResponses from 796 women were analysed. Half of the women (52.9%) had postmortem contact with their baby. 30.4% left the hospital with a least one linking object or a photograph. In 35.8% of cases parents weren’t given any option to recover the body/remains. 22.9% of births ≥26 weeks gestation were by caesarean, with a significant (p < 0.001) difference between public hospitals (16.8%) and private hospitals (41.5%). 29.3% of respondents were not accompanied during the delivery. 48.0% of respondents recalled being administered sedatives at least once during the hospital stay. The autopsy rate in stillbirth cases (≥ 20 weeks) was 70.5% and 44.4% in cases of termination of pregnancy (all gestational ages). Consistent significant (p < 0.05) differences in care practices were found based on gestational age and type of hospital (public or private), but not to other variables related to socio-demographics, pregnancy history or details of the loss/death. Intrauterine deaths at earlier gestational ages received poorer quality care.ConclusionsSupportive healthcare following intrauterine death is important to women’s experiences in the hospital and beneficial to the grief process. Many care practices that are standard in other high-income countries are not routine in Spanish hospitals. Providing such care is a relatively new phenomenon in the Spanish health system, the results provide a quality benchmark and identify a number of areas where hospitals could make improvements to care practices that should have important psychosocial benefits for women and their families.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1630-z) contains supplementary material, which is available to authorized users.

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“…Al-Zirqi et al, in 2016, concluded that a major risk factor for complete uterine rupture in intact and scarred uteri was the sequential labor induction with prostaglandins and oxytocin, compared to spontaneous labor [7]. Other significant risk factors include labor augmentation with oxytocin, antepartum fetal death and previous first-trimester miscarriages [10].…”

Section: Discussionmentioning

confidence: 99%

Combined Rupture of Vaginal Vault and Unscarred Uterus and Neonatal Death Following Induction of Labor with Misoprostol

Darido¹,

Khazaal²,

Bazzi³

et al. 2019

OJOG

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Introduction: Rupture of unscarred uterus (primary uterine rupture) is a rare peripartum complication often associated with catastrophic maternal and neonatal outcomes. Case presentation: A 27-year-old primigravid lady, previously healthy, at 40 weeks + 2 days presented to a midwife's clinic for routine antenatal consultation. She was advised to have induction of labor. This was initiated with 2 tablets of Misoprostol (400 mcg) vaginally. Twelve hours later, and after remaining at full cervical dilation for 4 hours, she was referred to our maternity service for alleged failure to descend. On arrival, she was apprehensive, exhausted but hemodynamically stable. Pelvic exam disclosed a fully dilated cervix with the vertex at S + 1 and a caput reaching the introitus. No fetal heart rate could be elicited by the CTG monitor and this was verified by a bedside ultrasonography. Operative vaginal delivery was performed due to maternal exhaustion. This was complicated by transient shoulder dystocia. Manual revision of the birth canal and the uterine cavity disclosed a suspicion of left vaginal vault gapping together with a left fundal uterine rupture. Consequently, the patient was rushed to the operating room for an urgent exploratory laparotomy. The rupture sites were identified and repaired while a large broad ligament hematoma on the same side was explored and hemostasis secured with ipsilateral uterine artery ligation of the fundal and cervical branches. The postoperative course was smooth and the patient left the hospital on the 5 th day postpartum. Conclusion: Cases of unscarred uterine rupture are limited. One of the most frequent risk factor is the injudicious use of Misoprostol for labor induction. Sudden arrest of progress of labor or failure to descend might mask uterine rupture. We recommend that all birth attendants be familiar with the guidelines issued by FIGO, ACOG and other societies for the safe use of these potent uterotonics.

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Risk factors for complete uterine rupture

Abstract: Sequential labor induction with prostaglandins and oxytocin and augmentation of labor with oxytocin are important risk factors for complete uterine rupture in intact and scarred uteri.

Cited by 111 publications

References 18 publications

Predictors of uterine rupture in a large sample of women in Senegal and Mali: cross-sectional analysis of QUARITE trial data

Predictors of uterine rupture in a large sample of women in Senegal and Mali: cross-sectional analysis of QUARITE trial data

Care quality following intrauterine death in Spanish hospitals: results from an online survey

Combined Rupture of Vaginal Vault and Unscarred Uterus and Neonatal Death Following Induction of Labor with Misoprostol

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