Unscarred uterine rupture and subsequent pregnancy outcome — a tertiary centre experience

Abstract

Objectives: The aim of this study was to investigate the incidence, etiology and obstetric outcomes of rupture in unscarred uterine rupture and in those with a history of uterine rupture Material and methods: The hospital records of women who had delivered between May 2005 and May 2017 at a tertiary center were examined retrospectively. Data on patients with unscarred uterine rupture in pregnancy who had undergone fertility-preserving surgery were evaluated. Results: During the study period, 185,609 deliveries occurred. Of those, unscarred uterine rupture has occurred in 67 women. There were no ruptures reported in nulliparous women. The rupture was observed in the isthmic region in 60 (89.6%) patients and in the fundus in 7 (10.4%) patients. Thirty-eight (56.7%) patients had undergone a total or subtotal hysterectomy, and 29 (43.3%) patients had received primary repair. Ten patients had reconceived after the repair. Of these, eight patients who had a history of isthmic rupture, successfully delivered by elective C-section at 36-37 wk. of gestation, and two experienced recurrent rupture at 33 and 34 wk. of gestation, respectively. Both patients had a history of fundal rupture, and their inter-pregnancy interval was 9 and 11 mo., respectively. Conclusions: The incidence of rupture in unscarred pregnant uteri was found to be one per 2,770 deliveries. Owing to the high morbidity, regarding more than half of the cases with rupture eventuated in hysterectomy, clinicians should be prudent in induction of labour for multiparous women since it was the main cause of rupture in this series. Short inter-pregnancy intervals and history of fundal rupture may confer a risk for rupture recurrence. Those risk factors for recurrence should be validated in another studies.

Decision to Delivery Interval, Fetal Outcomes and Its Factors Among Emergency Caesarean Section Deliveries at South Gondar Zone Hospitals, Northwest Ethiopia: Retrospective Cross-Sectional Study, 2020

“…In such cases, poor results such as hysterectomy, hypogastric artery ligation, and relaparotomy have been reported. [31][32][33][34] In our finding, almost half of the operation (50.8%) was conducted by emergency surgeons and 49.2% by senior obstetricians. DDI attainment less than 30 minutes was 6.2% vs 29.1%, respectively.…”

Uterine dehiscence in pregnant with previous caesarean delivery

“…It is a strong predictor of uterine scar defects in women with a previous caesarean section [14,15]. It has been suggested that the risk of recurrent uterine ruptures can be reduced by elective caesarean section at 36-37 weeks gestational age, in women with a history of isthmic rupture, and at 32-33 weeks gestational age after foetal lung maturation in women with a history of fundal uterine rupture and those with short inter-pregnancy intervals [16]. However, there is currently no gold standard for diagnosing caesarean scar dehiscence [11].…”

Maternal and perinatal outcome in rupture of unscarred uterus: a case series

“…4 Similar to the study by Nurullah Peker et al in which more than half (56.7%) of cases under went hysterectomy, the present study also had more than half (55.5%) cases who underwent hysterectomy. 8,9 In most of the patient's rupture occurred in the lower uterine segment and hysterectomy was performed in most of them.…”

“…In the literature, the risk factors for unscarred uterine rupture are: high parity, use of uterotonic drugs, advanced maternal age, dystocia, macrosomia and possibly short inter-pregnancy intervals. [7][8][9][10][11] High incidence in this study is a reflection of prolonged trial of labour at home, delay in referral of the cases from peripheral health centers and further delay due to poor transport facilities in the rural area. A high index of suspicion should be held when labor involves unbooked patients, grand multiparity, or previously scarred uterus.…”