Risk factors and outcomes associated with type of uterine rupture

Dimitrova, Desislava; Kästner, Anika; Schwickert, Axel C.; Henrich, Wolfgang; Braun, Thorsten

doi:10.1007/s00404-022-06452-0

Cited by 15 publications

(9 citation statements)

References 45 publications

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“…Multiparity has been demonstrated as a risk factor for uterine rupture and most women with uterine rupture are multiparous 17,18 . This study detected a threefold increased risk among multiparous women compared with nulliparous women, but not compared with uniparous women after adjusted analyses.…”

Section: Discussionmentioning

confidence: 51%

Risk of uterine rupture in multiparous women after induction of labor with prostaglandin: A national population‐based cohort study

Ryberg,

Carlsson,

Svensson

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo assess whether, after induction of labor with prostaglandin, multiparous (≥2 para) women have an increased risk of uterine rupture compared with nulliparous or uniparous women.MethodsThis was a retrospective population‐based cohort study including women who underwent induction with prostaglandin in all maternity wards in Sweden between May 1996 and December 2019 (n = 56 784). The study cohort was obtained by using data from the Swedish Medical Birth Register, which contains information from maternity and delivery records. The main outcome measure was uterine rupture.ResultsOverall, multiparous women induced with prostaglandin had an increased risk of uterine rupture compared with nulliparous women (adjusted odds ratio [OR], 3.33 [95% confidence interval (CI), 1.38–8.04]; P < 0.007). Multiparous women with no previous cesarean section (CS) induced with prostaglandin had more than three times higher risk of uterine rupture (crude OR, 3.55 [95% Cl, 1.48–8.53]; P = 0.005) compared with nulliparous women and four times higher risk compared with uniparous women (OR, 4.10 [95% CI, 1.12–15.00]; P < 0.033). Multiparous women with previous CS had a decreased risk of uterine rupture compared with uniparous women with one previous CS (crude OR, 0.41 [95% Cl, 0.21–0.78]; P = 0.007).ConclusionOur study implies that multiparity in women with no previous CS is a risk factor for uterine rupture when induced with prostaglandin. This should be taken into consideration when deciding on the appropriate method of induction.

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Section: Discussionmentioning

confidence: 51%

Risk of uterine rupture in multiparous women after induction of labor with prostaglandin: A national population‐based cohort study

Ryberg,

Carlsson,

Svensson

et al. 2023

Intl J Gynecology & Obste

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“…Recent literature showed that transvaginal and hystoroscopic surgical approaches are effective [17,18]. The CSD may be a risk factor for uterine rupture in pregnancy [19]. Clear elucidation of uterine mechanics is key to understanding healing of cesarean incisions [20,21].…”

Section: Discussionmentioning

confidence: 99%

Postpartum Changes in Uterine Position and Occurrence of Cesarean Scar Defects: A Retrospective Observational Study

Pan¹,

Gu²,

Yu³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Background: Over the past several decades, rates of cesarean delivery have increased considerably worldwide. As cesarean section (CS) may also result in changes to uterine position, the relationship between delivery modes, postpartum uterine position and cesarean scar defect (CSD) warrants elucidation. Materials & Methods: Here, we conducted a retrospective observational study evaluating 921 women (482 underwent vaginal delivery and 439 underwent CS) who had undergone transvaginal ultrasonography (TVU) early in their pregnancy (<8 weeks). Subsequent ultrasonography was performed 3-6 months postpartum to evaluate uterine position for all women and saline infusion sonohysterography (SIS) for women who underwent CS. The outcome was the uterine position for all of the women and the CSD for women underwent CS. Results: A total of 716 women (371 of whom underwent vaginal delivery and 345 of whom underwent CS) were concluded in the study. Postpartum uterine position was found to be significantly changed from anteflexion (81.9% for vaginal delivery and 82.0% for CS) to retroflexion (29.1% for vaginal delivery and 46.7% for CS) after both vaginal (p < 0.001) and CS (p < 0.001) deliveries. CSD was diagnosed by SIS in 146 of 345 (42.3 95% CI 37.1-47.6) women that underwent CS. CSD prevalence among anteflexed and retroflexed uterus were 46.7% (95% CI 39.5%-54.0%) and 37.3% (95% CI 29.7%-44.8%), respectively (p = 0.08). Conclusions: This study revealed that uterus became retroflexed in patients who underwent either CS or vaginal deliveries. CS resulted in a significantly greater proportion of retroflexed uterus than did vaginal delivery. CSD prevalence among women with retroflexed uterus in the postpartum has no difference with those with anteflexed uterus.

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“…Caesarean delivery (CD) leaves a scar in the uterus and constitutes the main risk factor for uterine rupture during subsequent delivery. 1 Until today, there are no drugs or techniques that enhance uterine wound healing at the time of CD to such an extent that the risk of uterine rupture during subsequent pregnancy could be eliminated. 2,3 While scarring and fibrosis in the skin or the lung have been very intensively researched with stem cells-based organoid models and novel biological therapy approaches, scarring of the uterine wall is still a 'neglected disease' in the research area of tissue regeneration.…”

Section: Introductionmentioning

confidence: 99%

“…Caesarean delivery (CD) leaves a scar in the uterus and constitutes the main risk factor for uterine rupture during subsequent delivery 1 . Until today, there are no drugs or techniques that enhance uterine wound healing at the time of CD to such an extent that the risk of uterine rupture during subsequent pregnancy could be eliminated 2,3 .…”

Section: Introductionmentioning

confidence: 99%

Uterine scars after caesarean delivery: From histology to the molecular and ultrastructural level

Paping,

Basler,

Ehrlich

et al. 2023

Wound Repair Regeneration

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Uterine rupture during a trial of labor after caesarean delivery (CD) is a serious complication for mother and fetus. The lack of knowledge on histological features and molecular pathways of uterine wound healing has hindered research in this area from evolving over time. We analysed collagen content and turnover in uterine scars on a histological, molecular and ultrastructural level. Therefore, tissue samples from the lower uterine segment were obtained during CD from 16 pregnant women with at least one previous CD, from 16 pregnant women without previous CD, and from 16 non‐pregnant premenopausal women after hysterectomy for a benign disease. Histomorphometrical collagen quantification showed, that the collagen content of the scar area in uterine wall specimens after previous CD was significantly higher than in the unscarred myometrium of the same women and the control groups. Quantitative real‐time PCR of uterine scar tissue from FFPE samples delineated by laser microdissection yielded a significantly higher COL3A1 expression and a significantly lower COL1A2/COL3A1 ratio in scarred uteri than in samples from unscarred uteri. Histological collagen content and the expression of COL1A2 and COL3A1 were positively correlated, while COL1A2/COL3A1 ratio was negatively correlated with the histological collagen content. Transmission electron microscopy revealed a destroyed myometrial ultrastructure in uterine scars with increased collagen density. We conclude that the high collagen content in uterine scars results from an ongoing overexpression of collagen I and III. This is a proof of concept to enable further analyses of specific factors that mediate uterine wound healing.

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Risk factors and outcomes associated with type of uterine rupture

Cited by 15 publications

References 45 publications

Risk of uterine rupture in multiparous women after induction of labor with prostaglandin: A national population‐based cohort study

Risk of uterine rupture in multiparous women after induction of labor with prostaglandin: A national population‐based cohort study

Postpartum Changes in Uterine Position and Occurrence of Cesarean Scar Defects: A Retrospective Observational Study

Uterine scars after caesarean delivery: From histology to the molecular and ultrastructural level

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