Rupture of the scarred uterus

Grossetti, E.; Vardon, Delphine; Créveuil, Christian; Herlicoviez, M.; Dreyfus, Michel

doi:10.1080/00016340701257141

Cited by 17 publications

(15 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We further confirm risk factors such as abnormal placentation and increased maternal age as already described [22]. Induction of labor is postulated as important risk factor by many other authors, although this conclusion was not supported by all published studies [3,4,23,24]. In our study population, induction of labor in patients with previous uterine surgery seemed to be associated with uterine rupture (P < 0.01).…”

Section: Discussioncontrasting

confidence: 29%

Risk factors of uterine rupture with a special interest to uterine fundal pressure

Sturzenegger

Schäffer

Zimmermann

et al. 2017

Journal of Perinatal Medicine

View full text Add to dashboard Cite

PURPOSE Uterine rupture is a rare but serious event with a median incidence of 0.09%. Previous uterine surgery is the most common risk factor. The aim of our study was to analyze retrospectively women with uterine rupture during labor and to evaluate postulated risk factors such as uterine fundal pressure (UFP). METHODS Twenty thousand one hundred and fifty-two deliveries were analyzed retrospectively. Inclusion criteria were 22 weeks and 0 days-42 weeks and 0 days of gestation, singleton pregnancy and cephalic presentation. Women with primary cesarean section were excluded. A logistic regression analysis adjusting for possible risk factors was conducted and a subgroup analysis of women with unscarred uterus was performed. RESULTS Twenty-eight cases of uterine rupture were identified (incidence: 0.14%). Uterine rupture was noticed in multipara patients only. In the multivariate analysis among all study patients, only previous cesarean section remained a statistically significant risk factor [adjusted odds ration (adj. OR) 12.52 confidence interval (CI) 95% 5.21-30.09]. In the subgroup analysis among women with unscarred uterus (n=19,415) three risk factors were associated with uterine rupture: UFP (adj. OR 5.22 CI 95% 1.07-25.55), abnormal placentation (adj. OR 20.82 CI 95% 2.48-175.16) and age at delivery >40 years (adj. OR 4.77 CI 95% 1.44-15.85). CONCLUSIONS The main risk factor for uterine rupture in the whole study population is previous uterine surgery. Risk factors in women with unscarred uterus were UFP, abnormal placentation, and age at delivery >40 years. The only factor which can be modified is UFP. We suggest that UFP should be used with caution at least in presence of other supposed risk factors. AbstractPurpose: Uterine rupture is a rare but serious event with a median incidence of 0.09%. Previous uterine surgery is the most common risk factor. The aim of our study was to analyze retrospectively women with uterine rupture during labor and to evaluate postulated risk factors such as uterine fundal pressure (UFP). Methods: Twenty thousand one hundred and fifty-two deliveries were analyzed retrospectively. Inclusion criteria were 22 weeks and 0 days-42 weeks and 0 days of gestation, singleton pregnancy and cephalic presentation. Women with primary cesarean section were excluded. A logistic regression analysis adjusting for possible risk factors was conducted and a subgroup analysis of women with unscarred uterus was performed. Results: Twenty-eight cases of uterine rupture were identified (incidence: 0.14%). Uterine rupture was noticed in multipara patients only. In the multivariate analysis among all study patients, only previous cesarean section remained a statistically significant risk factor [adjusted odds ration (adj. OR) 12.52 confidence interval (CI) 95% 5.21-30.09]. In the subgroup analysis among women with unscarred uterus (n = 19,415) three risk factors were associated with uterine rupture: UFP (adj. OR 5.22 CI 95% 1.07-25.55), abnormal placentation ) and age at delivery > 40 year...

show abstract

Section: Discussioncontrasting

confidence: 29%

Risk factors of uterine rupture with a special interest to uterine fundal pressure

Sturzenegger

Schäffer

Zimmermann

et al. 2017

Journal of Perinatal Medicine

View full text Add to dashboard Cite

show abstract

“…40 The impact of induction Induction of labour, especially with prostaglandins, increased the risk of uterine rupture in this sample as demonstrated elsewhere. 26,33,[41][42][43][44][45][46] Buhimschi et al 46 found that women induced with prostaglandins were more likely to rupture at the site of the uterine scar than those induced with oxytocin, suggesting that prostaglandins could induce local, biochemical modifications that weaken the scar, predisposing to rupture. Amniotomy and other mechanical methods carried lower risk of rupture than prostaglandin.…”

Section: 39mentioning

confidence: 99%

Uterine rupture after previous caesarean section

Al-Zirqi

Stray‐Pedersen

Forsén

et al. 2010

BJOG

135

View full text Add to dashboard Cite

show abstract

“…Controversy remains with respect to earlier stated additional risk of induction of labour with prostaglandins. Several studies report that induction with prostaglandins confers the highest risk of uterine rupture (relative risk up to 15), but two large studies could not confirm this 4,19,20 . Case ascertainment was suboptimal using ICD‐9 codes, and bias by indication may also have played a role.…”

Section: Discussionmentioning

confidence: 99%

Uterine rupture in the Netherlands: a nationwide population‐based cohort study

Zwart

Richters

Öry

et al. 2009

BJOG

256

241

View full text Add to dashboard Cite

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.

show abstract

Rupture of the scarred uterus

Abstract: In women with a scarred uterus, prostaglandin E2 induction of labour is a risk factor for uterine rupture. The practice of a systematic cesarean section in cases with Bishop score<3, appropriate induction procedure, and rigorous monitoring of the labour, could make for a safer delivery.

Cited by 17 publications

References 35 publications

Risk factors of uterine rupture with a special interest to uterine fundal pressure

Risk factors of uterine rupture with a special interest to uterine fundal pressure

Uterine rupture after previous caesarean section

Uterine rupture in the Netherlands: a nationwide population‐based cohort study

Contact Info

Product

Resources

About