Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health

Abstract

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.

Elective repeat cesarean delivery in women eligible for trial of labor in Brazil

“…Although the overall repeat CD rate in the present study is similar to that observed in the WHO Multicountry Survey (79.4% vs 81.5%, respectively), the present ERCD rate is 50% higher than that reported by the WHO (66.1% vs 43.0%). The repeat CD rate in the present study is also higher than that in European countries, such as France (65%) and the Netherlands (53%) .…”

Determinants of uterine rupture in Dessie Referral Hospital, North East Ethiopia, 2016: case control design

“…Systematic review of literature showed that median incidence of uterine rupture was 5.3 per 10 000 births with much higher incidence in developing countries. 11,13,14 In developed countries the incidence is less than 1 per 1000 deliveries. 15,16 Different studies in Ethiopia showed that the incidence of uterine rupture ranges from 0.3% to 2.4%.…”

“…[4][5][6][7] It is associated with significant uterine bleeding and fetal distress necessitating prompt delivery, major surgery or uterine rent. [8][9][10][11] It is an obstetric catastrophe contributing for as many as 9.3% of maternal deaths. 12 The incidence of ruptured uterus varies in different parts of the world.…”

Uterine Rupture: A Two-Year Review at a Teaching Institution

“…[7] The reported incidence of uterine rupture among women with prior CS ranged from 0.2% in high human development index (HDI) countries to 1% in low HDI countries and in India the incidence is 1.69%. [8,9] Rupture of an unscarred uterus may be either traumatic or spontaneous. Traumatic factors include mid to high operative vaginal deliveries, assisted breech delivery, internal podalic version, abdominal trauma, labour induction and in particular the unmonitored usage of oxytocin or prostaglandins.…”