Uterine rupture: trends over 40 years

Al-Zirqi, Iqbal; Stray‐Pedersen, Babill; Forsén, Lisa; Daltveit, AK; Vangen, Siri

doi:10.1111/1471-0528.13394

Cited by 89 publications

(83 citation statements)

References 25 publications

(29 reference statements)

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“…First, we may have missed additional ruptures that were not recorded in the MBRN because only 21 units were included in the PAS search, as mentioned in the Material and methods section. However, we found that the results were similar regarding risk factors for different maternal outcomes following complete uterine ruptures in both the previously fully validated sample of 163 ruptures and in our current larger sample of 247, which was partially validated. Therefore, we concluded that potentially misdiagnosed cases did not influence the study results.…”

Section: Discussionsupporting

confidence: 69%

“…This was a retrospective population‐based study including rupture cases identified in the whole pregnant population in Norway in 1967‐2008. In our two earlier papers on trends and risk factors for complete uterine ruptures, we included a validated population from 22 of the 48 maternity units in Norway, between 1967 and 2008 . In the current study we included the whole pregnant population of all 48 units, thus enlarging the sample of complete uterine ruptures.…”

Section: Methodsmentioning

confidence: 99%

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Maternal outcome after complete uterine rupture

Al-Zirqi

Daltveit

Vangen

2019

Acta Obstet Gynecol Scand

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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.

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Section: Discussionsupporting

confidence: 69%

Section: Methodsmentioning

confidence: 99%

Maternal outcome after complete uterine rupture

Al-Zirqi

Daltveit

Vangen

2019

Acta Obstet Gynecol Scand

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“…A study from the United States reported rupture of the unscarred uterus in 4.54 per 100,000 deliveries or about 1 in 22,000 deliveries [10]. The incidence of rupture in both scarred and unscarred uteri has increased during recent decades [12]. …”

Section: Discussionmentioning

confidence: 99%

Spontaneous Rupture of Pyometra in a Nonpregnant Young Woman

Mostafa-Gharabaghi

Bordbar

Vazifekhah

et al. 2017

Case Reports in Obstetrics and Gynecology

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A 40-year-old woman presented with severe vaginal bleeding. Initial workup with an abdominal sonography revealed endometrium for about 3 mm and free fluid in the abdomen. Hemodynamic instability with abdominal pain and free fluid in the abdomen prompted blood transfusion and laparotomy. There were about 1000 cc blood and clots in the abdomen at laparotomy. There was a longitudinal rupture from fundus up to cervix at the left side of the uterus. Tearing was in full thickness from serosa to endometrium. Scar of previous cesarean was transvers and not associated with this tearing. There was not any myomectomy scar.

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“…The risk of uterine rupture is much lower in unscarred uterus than scarred one. Regarding its incidence, different rates were mentioned in various articles (13). The mean rate is 0.009% in a period of 20 years (14).…”

Section: Introductionmentioning

confidence: 99%

Unexpected Rupture of Unscarred Uterus at 12 Weeks of Pregnancy: A Case Report and Literature Review

Vaezi¹

2017

International Journal of Women’s Health and Reproduction Scienc

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IntroductionUterine rupture is an unusual but serious event in pregnancy. Most cases of uterine rupture occur in the second and third trimesters in the scarred uterus (such as previous caesarean section, hysterotomy or myomectomy) (1). The unscarred uterine rupture is an infrequent condition predisposed by multiparity, malpresentation, use of uterotonic drugs (such as oxytocin or prostaglandins), and connective tissue diseases (2). There are some reports regarding uterine rupture in the absence of labor, without any risk factors (3-9). The chief predisposing factor for unscarred uterine rupture is multiparity (3). On the other hand, unscarred uterine rupture in the absence of labor in the first trimester of pregnancy is a very rare phenomenon on which 3 cases were reported (10-12).In this paper, a very rare case of unscarred uterine rupture in the first trimester in the absence of labor is presented where multiparity was the only risk factor. Case PresentationA 34 years old female with a history of vaginal delivery, gravida 2, para 1, and gestational age of 12-13 weeks referred to the emergency room of Tabriz Taleghani hospital. Her chief complain was abdominal pain. She was alert and oriented. She had no fever, chills, nausea, vomiting, vaginal bleeding or signs of delivery. She had no history of surgery, curettage, and abortion. Past medical history was negative. On physical examination, vital signs were stable. Abdominal examination revealed mild tenderness in the right lower quadrant, and cervix was normal and closed in gynecological examination. In laboratory tests, Hb was 10.6 mg/dL The patient was hospitalized and observed. Ultrasound was performed due to persistence and exacerbation of abdominal pain, and showed the intrauterine gestational sac with a live fetus of 12 weeks and 3 days. The amniotic fluid and adnexa were normal, and a lot of free liquid was seen in abdomen and pelvis which was infiltrated into the splenorenal and Morrison's space. Given the possibility of hemoperitoneum, she underwent urgent laparotomy through a midline incision, and there was about 2 L of blood in the abdomen and pelvis. A rupture of about 5 cm was found on the posterior wall of the uterus. Placenta and fetus with intact sac were bulging into the abdomen from the rupture site. There was an active bleeding from uterine rupture. Fetus and placenta were removed completely and the rupture was repaired in three layers of endometrium, myometrium, and perimetrium. The patient received two units of isogroup packed red blood cells and she was discharged on the third day (Figures 1 and 2). AbstractObjectives: Uterine rupture is an infrequent but serious event in pregnancy, which happens commonly in the second and third trimesters in scarred uteruses and labor phases. Uterine rupture during labor is very rare in the absence of scar and occurs mainly in multiparous women. This article introduces a very unusual case of unexpected rupture of an unscarred uterus in the 12th week of gestation. Case Presentation: A 34 year old woman with...

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Uterine rupture: trends over 40 years

Cited by 89 publications

References 25 publications

Maternal outcome after complete uterine rupture

Maternal outcome after complete uterine rupture

Spontaneous Rupture of Pyometra in a Nonpregnant Young Woman

Unexpected Rupture of Unscarred Uterus at 12 Weeks of Pregnancy: A Case Report and Literature Review

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