Maternal outcome after complete uterine rupture

Abstract

Introduction Complete uterine rupture, a rare peripartum complication, is often associated with a catastrophic outcome for both mother and child. However, few studies have investigated large datasets to evaluate maternal outcomes after complete ruptures, particularly in unscarred uteri. This paucity of studies is partly due to the rarity of both the event and the serious outcomes, such as peripartum hysterectomy and maternal death. The incidence of uterine rupture is expected to increase, due to increasing cesarean section rates worldwide. Thus, it is important to have more complete knowledge about the immediate maternal outcome following a complete uterine rupture. The objective was to identify maternal outcomes and their risk factors following complete uterine ruptures. Material and methods This was a population‐based study using data from the Medical Birth Registry of Norway, the Patient Administration System and medical records. Maternities with complete uterine rupture after start of labor in Norway during 1967‐2008 (n = 247 births), identified among 2 209 506 women. Uterine ruptures were identified from both registries and were further studied through a review of medical records. Only complete ruptures were included in analysis. The associations between maternal outcomes and demographic and labor risk factors were estimated. Odds ratios (ORs) were determined with crude logistic regressions for each risk factor. Separate multivariable logistic regressions were performed to calculate adjusted odds ratios and 95% confidence intervals (CIs). Results We identified 88 (35.6%) healthy mothers, 107 (43.3%) severe postpartum hemorrhages without hysterectomy, 51 (20.6%) peripartum hysterectomies, and three (1.2%) maternal deaths. Peripartum hysterectomy decreased significantly in the last years of study. Unscarred uterine ruptures significantly increased the risk of peripartum hysterectomy compared with scarred uterine ruptures (AOR 2.6, 95% CI 1.3‐5.3). Other factors that increased the risk of peripartum hysterectomy following rupture were: maternal age ≥35 years (AOR 2.3, 95% CI 1.1‐5.0), parity ≥3 vs parity 1‐2 (AOR 2.8, 95% CI 1.2‐6.7), and rupture detection after vaginal delivery (AOR 2.2, 95% CI 1.1‐4.8). Conclusions Unscarred uteri, older maternal age, parity ≥3, and rupture detection after vaginal delivery showed the highest associations with the risk of peripartum hysterectomy after complete uterine rupture.

Prevalence and determinants of uterine rupture in Ethiopia: a systematic review and meta-analysis

“…This study also revealed women who were para one were 88% less likely to have uterine rupture than women with multiparity. This finding is supported by different prior studies in different countries in Ethiopia 42 , Norway 8 , 69 , Senegal and Mali 56 , Uganda 51 , and Israel 70 . It might be attributed to the fact as increasing parity increases the elasticity and strength of the uterine muscle (Myometrium) decreases 38 , 71 .…”

“…This finding was also in line with a systematic review and meta-analysis in both developing and developed countries conducted by WHO 58 . This might be due to the higher teenage pregnancies in the corresponding countries secondary to low education attainment 59 like in Ethiopia 60 , Uganda 61 , Niger 62 , India 63 and Mali 64 in which teenagers usually have less developed pelvic canal 69 – 67 and have low ANC utilizations 68 , 69 .…”

Uterine rupture in a gravid, unscarred uterus: A case report

“…The researchers discovered that, among women with an unscarred uterus, those aged over 35 years, having a parity of at least 3, being born in a non-Western country, and having a previous miscarriage before 12 weeks put them at a particularly high risk for rupture. Of greatest significance, they found that oxytocin has a higher odds ratio for rupture than induction with prostaglandins (6.5 and 4.5, respectively), and that the sequential use of prostaglandins and oxytocin had an odds ratio of 48 [10].…”

Human Mesenchymal Stem Cell Sheets Improve Uterine Incision Repair in a Rodent Hysterotomy Model

“…Morbidities related to uterine rupture include severe postpartum hemorrhage; almost half of these cases require blood transfusion, and 20% require hysterectomy. 9 Fetal and neonatal complications are also substantial, including up to 6% injury from hypoxic-ischemic encephalopathy up to 6%, neonatal intensive care admission in up to 50%, and fetal or neonatal death in up to 26% of cases. 10…”