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Al-Zirqi I, Vangen S. Prelabour uterine rupture: characteristics and outcomes. BJOG 2020; 127:1637-1644. [PMID: 32534459 DOI: 10.1111/1471-0528.16363] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the characteristics and outcomes of prelabour uterine ruptures. DESIGN Descriptive study based on population data from the Medical Birth Registry of Norway, the Patient Administration System and medical records. SAMPLE Maternities with uterine rupture before start of labour in Norway during the period 1967-2008 (8 complete ruptures among 2 334 712 women with unscarred uteri, and 22 complete and 45 partial ruptures among 121 085 women with scarred uteri). METHOD We measured the rate of perinatal deaths and peripartum hysterectomy following ruptures. In addition, we studied the characteristics of ruptures. RESULTS The eight complete ruptures in women with unscarred uteri were associated with trauma from traffic accidents (n = 3; 37.5%), previous curettage (n = 3; 37.5%) and congenital uterine malformations (n = 2; 25%), resulting in seven perinatal deaths and two hysterectomies. The 22 complete ruptures in scarred uteri were mostly outside the lower uterine segment (n = 17; 72.7%). Abnormally invasive placenta (AIP) and previous rupture were present in four (18.2%) and three women (13.6%), respectively. They resulted in nine perinatal deaths (39.1%) and two hysterectomies (9.1%). The 45 partial ruptures involved mostly scars in the lower uterine segment (n = 39; 86.7%). None of them resulted in perinatal death or hysterectomy. Perinatal deaths have decreased dramatically in recent years, despite increasing prelabour rupture rates. CONCLUSION Although complete uterine ruptures before labour start were rare, they often resulted in catastrophic outcomes, such as perinatal death. Scars outside the lower segment were associated with a higher percentage of catastrophic prelabour ruptures compared with scars in the lower segment (Video S1). TWEETABLE ABSTRACT Complete prelabour uterine ruptures were rare, but resulted in high perinatal deaths, especially if they were in scars outside the lower segment.
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Affiliation(s)
- I Al-Zirqi
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway.,Women and Children's Division, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - S Vangen
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Gremillet L, Morello L, D'Ercole C, Carcopino X, Blanc J, Netter A. Be prepared for unexpected events: A case of vaginal rupture during breech delivery. Eur J Obstet Gynecol Reprod Biol 2020; 251:280. [PMID: 32505515 DOI: 10.1016/j.ejogrb.2020.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Letizia Gremillet
- Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Léa Morello
- Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Claude D'Ercole
- Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France; EA 3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Xavier Carcopino
- Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Institut Méditerranéen de Biodiversité et d'Écologie marine et continentale (IMBE), Aix Marseille University, CNRS, IRD, Avignon University, Marseille, France
| | - Julie Blanc
- Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France; EA 3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Antoine Netter
- Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Institut Méditerranéen de Biodiversité et d'Écologie marine et continentale (IMBE), Aix Marseille University, CNRS, IRD, Avignon University, Marseille, France.
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Influence of Caesarean section-pregnancy interval on uterine rupture risk and IVF pregnancy rates: systematic review and mathematical modelling. Reprod Biomed Online 2019; 39:809-818. [PMID: 31668670 DOI: 10.1016/j.rbmo.2019.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 11/21/2022]
Abstract
RESEARCH QUESTION What is the influence of the Caesarean section-pregnancy interval (CSPI) on the risk of uterine rupture, and what are the repercussions on IVF pregnancy rates of prolonging it? STUDY DESIGN Systematic searches were performed using PubMed MEDLINE to identify studies published up until July 2017 for articles with the following keywords: 'interdelivery interval' and 'uterine rupture'; 'interpregnancy interval' and 'uterine rupture'; 'interpregnancy interval' and 'cesarean section'; and 'uterine rupture' and 'cesarean section'. The search identified 1609 articles, of which six were included (involving 56,419 women). Four reported significantly higher uterine rupture rates in cases of a short CSPI. RESULTS From the analysis, the uterine rupture rate can be modelled by a formula corresponding to a hyperbolic curve. There is no clear cut-off in uterine rupture in relation to CSPI. The curve showed a sharp decrease in uterine rupture until the 10th month of CSPI (uterine rupture rate 0.7%), then a moderate and steady decrease until the 40th month (uterine rupture rate 0.4%) and afterwards a very mild decrease. From the data it is possible to calculate, according to the age of the woman, the expected reduction in IVF rates and uterine rupture as CSPI increases. CONCLUSION The risk of uterine rupture in relation to CSPI can be represented by means of a hyperbolic curve. After a 10-month CSPI, the expected uterine rupture rate is close to 0.7%. The impact of prolonging or reducing this interval on IVF pregnancy rates can be easily obtained from the table included in the article. This should be helpful in the decision-making process for both patients and physicians.
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Hua Z, Wu M. Spontaneous rupture of the uterus following salpingectomy: a case report and literature review. J Int Med Res 2019; 47:5328-5336. [PMID: 31554449 PMCID: PMC6833417 DOI: 10.1177/0300060519874903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Laparoscopic salpingectomy (LPSC) is the main treatment for ectopic pregnancy, which leads to spontaneous uterine rupture (UR) during pregnancy. We report the characteristics of a woman who had spontaneous UR during pregnancy with a history of salpingectomy. We experienced a 31-year-old woman with a UR in pregnancy with a history of LPSC twice. The patient had a successful pregnancy. We also performed a literature review including cases with spontaneous UR after LPSC. Twenty-seven case reports of 48 women were included in our review. Thirty-five (83.33%, 35/42) women previously received LPSC and 15 (31.25%) developed interstitial pregnancies. The interval between pregnancy and the last surgery did not affect the frequency of interstitial pregnancy and gestational age. Fetal outcomes in patients with UR at the third trimester were better than those at the first and second trimesters. We suggest that close observation and timely treatment by experienced clinicians lead to good outcomes of pregnant women with suspected UR.
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Affiliation(s)
- Zhifen Hua
- Department of Obstetrics, Changning Maternity & Infant Health Hospital of Shanghai, Shanghai, China
| | - Minjun Wu
- Department of Obstetrics, Changning Maternity & Infant Health Hospital of Shanghai, Shanghai, China
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Hochler H, Wainstock T, Lipschuetz M, Sheiner E, Ezra Y, Yagel S, Walfisch A. Grandmultiparity, maternal age, and the risk for uterine rupture-A multicenter cohort study. Acta Obstet Gynecol Scand 2019; 99:267-273. [PMID: 31505021 DOI: 10.1111/aogs.13725] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/30/2019] [Accepted: 09/03/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Uterine rupture is a critical complication causing fetal and maternal morbidity and mortality. Data are conflicting regarding whether grandmultiparity (parity ≥ 6) is a risk factor. This multicenter cohort study aimed to determine whether grandmultiparity (parity ≥ 6) poses a risk for uterine rupture in women with no previous cesarean delivery. MATERIAL AND METHODS A multicenter retrospective study of deliveries that occurred between the years 2003 and 2015 in three tertiary medical centers. Deliveries of grandmultiparous women were compared with those of multiparous women (parity 2-5). Women with previous cesarean deliveries were excluded. Multivariable regression modeling was applied to control for possible confounders. RESULTS A total of 388 784 deliveries of multiparous women with unscarred uteri were recorded during the study period, including 53 965 deliveries of grandmultiparous women and 334 819 deliveries of multiparous women. Grandmultiparous women were significantly older (33.9 ± 5 vs 27.3 ± 5 years; P < 0.0001). Fourteen cases of uterine rupture were recorded in the grandmultiparae group (1 per 3855 labors) vs 41 in the multiparae group (1 per 8166 labors) (odds ratio [OR] 2.07, 95% confidence interval [95% CI] 1.13-3.81; P = 0.030). However, in a multivariable model controlling for maternal age, the association between grandmultiparity and uterine rupture lost its significance (adjusted OR 1.26, 95% CI 0.66-2.41; P = 0.491), and maternal age emerged as an independent predictor of uterine rupture (adjusted OR 1.08, 95% CI 1.04-1.13; P < 0.0001). Additionally, the risk for uterine rupture was elevated in a linear fashion, concomitant with age. CONCLUSIONS Maternal age is a risk factor for uterine rupture. Grandmultiparity does not increase the risk beyond that associated with maternal age.
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Affiliation(s)
- Hila Hochler
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Tamar Wainstock
- School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michal Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.,The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Eyal Sheiner
- Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yossef Ezra
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
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Abstract
Abstract
Background
Uterine rupture is an extremely rare and unpredictable event for women undergoing trial of labor after cesarean delivery (TOLAC).
Case presentation
We present a patient with a lateral edge uterine rupture after TOLAC and our modified surgical technique for preventing complications of uterine atony.
Conclusion
Further case report studies are required in order to evaluate the effectiveness of our new-modified surgical technique in appropriate selected cases.
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Ye L, Cao W, Yao J, Peng G, Zhou R. Systematic review of the effects of birth spacing after cesarean delivery on maternal and perinatal outcomes. Int J Gynaecol Obstet 2019; 147:19-28. [PMID: 31233214 DOI: 10.1002/ijgo.12895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 04/17/2019] [Accepted: 06/20/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Little is known about the association between birth spacing and subsequent pregnancy outcomes after cesarean delivery. OBJECTIVES To summarize the effects of birth spacing after previous caesarean on maternal and perinatal outcomes. SEARCH STRATEGY Four online databases were searched via a multistage search strategy. SELECTION CRITERIA Studies assessing the effects of birth spacing on any adverse pregnancy outcome after cesarean were included. DATA COLLECTION AND ANALYSIS A narrative synthesis was completed. MAIN RESULTS Fifteen studies were included. Eight reported that interpregnancy interval (IPI) shorter than 6 months or birth interval (BI) shorter than 16-18 months increased the risk of uterine rupture during trial of labor after previous cesarean. Most studies found no association of birth spacing with vaginal delivery success following spontaneous labor, but the association with vaginal delivery after induced labor was less certain. BI shorter than 12 months was associated with increased risk of placenta previa and placental abruption. Few studies examined the effect of birth spacing after previous cesarean on perinatal outcomes. CONCLUSIONS IPI longer than 6-8 months or BI longer than 18 months was related to decreased risk of maternal morbidity and failed vaginal delivery after previous cesarean.
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Affiliation(s)
- Lei Ye
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) of Ministry of Education, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Wen Cao
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) of Ministry of Education, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jing Yao
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) of Ministry of Education, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ge Peng
- West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Rong Zhou
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) of Ministry of Education, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
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Nkwabong E, Ilue EE, Nana Njamen T. Factors associated with the resumption of sexual intercourse before the scheduled six-week postpartum visit. Trop Doct 2019; 49:260-264. [PMID: 31180803 DOI: 10.1177/0049475519855294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This retrospective cohort study was aimed at evaluating the factors associated with the resumption of sexual intercourse (SI) before the six-week postpartum visit and was carried out between 1 January and 15 February 2014. The main variables studied included maternal age, number of living children, mode of delivery, complications observed at delivery and resumption or not of SI. Data from women who resumed SI were compared to those of women who did not. Fisher's exact test and t-test were used for comparison. We recruited 120 women, among whom 95 (79.1%) resumed SI. Of these, 65/95 (68.4%) did not attend the postpartum visit while 30 (31.6%) did (P = 0.321). The factors associated with early resumption of SI were maternal age of 20-34 years (P < 0.001), women with one child (P < 0.004) and who had had an uncomplicated vaginal delivery (P < 0.001). Our conclusion is that nursing mothers should receive postpartum contraception before leaving the hospital.
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Affiliation(s)
- Elie Nkwabong
- Associate Professor, Department of Obstetrics & Gynecology, University Teaching Hospital/Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
| | - Elisabeth Ekuka Ilue
- Nurse, Department of Obstetrics & Gynecology, University Teaching Hospital, Yaoundé, Cameroon
| | - Théophile Nana Njamen
- Senior Lecturer, Department of Surgery, Obstetrics and Gynecology, Faculty of Health Sciences, University of Buea, Douala General Hospital, Douala, Cameroon
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Trial of labor after cesarean delivery in twin gestations: systematic review and meta-analysis. Am J Obstet Gynecol 2019; 220:336-347. [PMID: 30465748 DOI: 10.1016/j.ajog.2018.11.125] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/01/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Trial of labor after cesarean is offered as a routine option for singleton gestations with previous cesarean delivery. However, adequate data are not available to determine whether the approach is equally valid in women with twin gestation. OBJECTIVE This systematic review and meta-analysis aimed to assess maternal morbidities associated with trial of labor after cesarean delivery in twin gestations. STUDY DESIGN Electronic databases were searched for cohort studies and randomized controlled trials evaluating the association between trial of labor after cesarean delivery in twin gestations and pregnancy outcomes. Maternal mortality and severe morbidities, such as uterine rupture and hysterectomy, were compared between women who had trial of labor and women who had a planned repeat cesarean delivery. Pooled odds ratios were calculated using a random-effects model. Additional analyses were performed to compare trial of labor after cesarean outcomes in singleton and twin gestations. RESULTS Eleven cohort studies including a total of 8209 twin gestations with previous cesarean delivery were included in the present study. Of these gestations, 2484 were intended for planned vaginal birth and 5725 were intended for planned repeat cesarean delivery. The rate of uterine rupture in twin gestations was higher in the trial of labor after cesarean group than the elective cesarean group (odds ratio, 10.09, 95% confidence interval, 4.30-23.69, I2 = 68%). However, no statistically significant difference was found in the rate of uterine rupture between twin and single gestations attempting trial of labor after cesarean delivery (odds ratio, 1.34, 95% confidence interval, 0.54-3.31, I2 = 0%). Women who attempted a trial of labor after cesarean delivery with twins did not have an increased risk of uterine scar dehiscence, hemorrhage, blood transfusion, or neonatal morbidity and mortality compared with elective repeat cesarean delivery. Patients with twins had similar rates of successful vaginal delivery as patients with singletons (odds ratio, 0.85, 95% confidence interval, 0.61-1.18, I2 = 36%). CONCLUSION This meta-analysis demonstrates that, although trial of labor with twins after previous cesarean delivery is associated with higher rates of uterine rupture compared with elective cesarean delivery, pregnancy outcomes and success rates are similar to a trial of labor after previous cesarean delivery in singleton gestations. Planned vaginal birth for women with twin gestation and previous cesarean delivery may be a safe alternative to a planned repeat cesarean.
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Rottenstreich M, Khatib F, Mazaki E, Hirsch A, Sela HY. A rare presentation of uterine rupture - the risk of sequential labour induction with prostaglandins and oxytocin. J OBSTET GYNAECOL 2019; 39:714-715. [PMID: 30915873 DOI: 10.1080/01443615.2018.1553940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Misgav Rottenstreich
- a Department of Obstetrics and Gynecology , Shaare Zedek Medical Center, Hebrew University Medical School of Jerusalem , Jerusalem , Israel
| | - Fayez Khatib
- a Department of Obstetrics and Gynecology , Shaare Zedek Medical Center, Hebrew University Medical School of Jerusalem , Jerusalem , Israel
| | - Eyal Mazaki
- a Department of Obstetrics and Gynecology , Shaare Zedek Medical Center, Hebrew University Medical School of Jerusalem , Jerusalem , Israel
| | - Ayala Hirsch
- a Department of Obstetrics and Gynecology , Shaare Zedek Medical Center, Hebrew University Medical School of Jerusalem , Jerusalem , Israel
| | - Hen Y Sela
- a Department of Obstetrics and Gynecology , Shaare Zedek Medical Center, Hebrew University Medical School of Jerusalem , Jerusalem , Israel
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Al-Zirqi I, Daltveit AK, Vangen S. Maternal outcome after complete uterine rupture. Acta Obstet Gynecol Scand 2019; 98:1024-1031. [PMID: 30762871 DOI: 10.1111/aogs.13579] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/09/2019] [Indexed: 02/06/2023]
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.
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Affiliation(s)
- Iqbal Al-Zirqi
- Norwegian National Advisory Unit on Women's Health, Rikshospitalet, Oslo University Hospital, Oslo, Norway.,Women and Children's Division, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Anne Kjersti Daltveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway
| | - Siri Vangen
- Norwegian National Advisory Unit on Women's Health, Rikshospitalet, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Hutcheon JA, Nelson HD, Stidd R, Moskosky S, Ahrens KA. Short interpregnancy intervals and adverse maternal outcomes in high-resource settings: An updated systematic review. Paediatr Perinat Epidemiol 2019; 33:O48-O59. [PMID: 30311955 PMCID: PMC7380038 DOI: 10.1111/ppe.12518] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/16/2018] [Accepted: 07/29/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Currently, no federal guidelines provide recommendations on healthy birth spacing for women in the United States. This systematic review summarises associations between short interpregnancy intervals and adverse maternal outcomes to inform the development of birth spacing recommendations for the United States. METHODS PubMed/Medline, POPLINE, EMBASE, CINAHL, the Cochrane Database of Systematic Reviews, and a previous systematic review were searched to identify relevant articles published from 1 January 2006 and 1 May 2017. Included studies reported maternal health outcomes following a short versus longer interpregnancy interval, were conducted in high-resource settings, and adjusted estimates for at least maternal age. Two investigators independently assessed study quality and applicability using established methods. RESULTS Seven cohort studies met inclusion criteria. There was limited but consistent evidence that short interpregnancy interval is associated with increased risk of precipitous labour and decreased risks of labour dystocia. There was some evidence that short interpregnancy interval is associated with increased risks of subsequent pre-pregnancy obesity and gestational diabetes, and decreased risk of preeclampsia. Among women with a previous caesarean delivery, short interpregnancy interval was associated with increased risk of uterine rupture in one study. No studies reported outcomes related to maternal depression, interpregnancy weight gain, maternal anaemia, or maternal mortality. CONCLUSIONS In studies from high-resource settings, short interpregnancy intervals are associated with both increased and decreased risks of adverse maternal outcomes. However, most outcomes were evaluated in single studies, and the strength of evidence supporting associations is low.
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Affiliation(s)
- Jennifer A. Hutcheon
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Heidi D. Nelson
- Department of Medical Informatics and Clinical EpidemiologyOregon Health & Science UniversityPortlandOregon
| | - Reva Stidd
- Atlas ResearchWashingtonDistrict of Columbia
| | - Susan Moskosky
- US Department of Health and Human ServicesOffice of Population Affairs, Office of the Assistant Secretary for HealthRockvilleMaryland
| | - Katherine A. Ahrens
- US Department of Health and Human ServicesOffice of Population Affairs, Office of the Assistant Secretary for HealthRockvilleMaryland
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Getahun WT, Solomon AA, Kassie FY, Kasaye HK, Denekew HT. Uterine rupture among mothers admitted for obstetrics care and associated factors in referral hospitals of Amhara regional state, institution-based cross-sectional study, Northern Ethiopia, 2013-2017. PLoS One 2018; 13:e0208470. [PMID: 30513120 PMCID: PMC6279034 DOI: 10.1371/journal.pone.0208470] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/16/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Maternal morbidity and mortality have been one of the most challenging health problems that concern the globe over the years. Uterine rupture is one of the peripartum complications, which cause nearly about one out of thirteen maternal deaths. This study aimed to assess the prevalence and associated factors of uterine rupture among obstetric case in referral hospitals of Amhara Regional State, Northern Ethiopia. METHODS Institution based cross sectional study was conducted from Dec 5-2017-Jan 5-2018 on uterine rupture. During the study randomly selected 750 charts were included by using simple random sampling method. Data were checked, coded and entered into Epi info version 7.2 and then exported to SPSS Version 20 for Analysis. Binary Logistic regression was used to identify the predictors of uterine rupture and 95% Confidence Interval of odds ratio at p-value less than 0.05 was taken as a significance level. RESULT The overall prevalence of uterine rupture was 16.68% (95% CI: 14%, 19.2%). Distance from health facility >10km (Adjusted Odds Ratio (AOR) = 2.44; 95%CI:1.13,5.28), parity between II and IV (AOR = 7.26;95% (3.06,17.22)) and ≥V (AOR = 12.55;95% CI 3.64,43.20), laboring for >24hours(AO = 3.44; 95% CI:1.49,7.92), with referral paper(AOR = 2.94;95%CI:1.28,6.55) diagnosed with obstructed labor (AOR = 4.88;95%CI: 2.22,10.70), precipitated labor (AOR = 3.59;95%CI:1.10,11.77), destructive delivery (AOR = 5.18;95%: 1.22,20.08), No partograph (AOR = 5.21; 95% CI: 2.72,9.97), CPD(AOR = 4.08;95%CI:1.99,8.33), morbidly adherent placenta (AOR = 9.00;95%:2.46,27.11), gestational diabetic militias (AOR = 5.78; 95%CI:1. 12,20 .00 ), history of myomectomy(AOR = 5.00;95%CI:1.33,18.73), induction and augmentation of labor (AOR = 2.34;95%:1.15,4.72) obstetric procedure (AOR = 2.54;95%: 1.09,5.91), previous caesarian deliveries 4.90 (2.13,11.26) were found to be significantly associated with uterine rupture. CONCLUSION This finding showed that the prevalence of uterine rupture is higher. A more vigilant approach to prevent prolonged and obstructed labor, use of partograph, quick referral to a well-equipped center and prevention of other obstetrics complications need to be focused on.
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Affiliation(s)
- Worku Taye Getahun
- Department of Midwifery, Debremarkos Referral Hospital, Debremarkos, Ethiopia
| | | | | | - Habtamu Kebebe Kasaye
- Department of Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Lehmann S, Baghestan E, Børdahl PE, Irgens LM, Rasmussen S. Perinatal outcome in births after a previous cesarean section at high trial of labor rates. Acta Obstet Gynecol Scand 2018; 98:117-126. [DOI: 10.1111/aogs.13458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 07/11/2018] [Accepted: 08/01/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Sjur Lehmann
- Department of Clinical Science University of Bergen Bergen Norway
| | - Elham Baghestan
- Department of Obstetrics and Gynecology Haukeland University Hospital Bergen Norway
| | - Per E. Børdahl
- Department of Clinical Science University of Bergen Bergen Norway
- Department of Obstetrics and Gynecology Haukeland University Hospital Bergen Norway
| | - Lorentz M. Irgens
- Department of Global Public Health and Primary Care University of Bergen Bergen Norway
- Medical Birth Registry of Norway Norwegian Institute of Public Health Bergen Norway
| | - Svein Rasmussen
- Department of Clinical Science University of Bergen Bergen Norway
- Department of Obstetrics and Gynecology Haukeland University Hospital Bergen Norway
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Delafield R, Pirkle CM, Dumont A. Predictors of uterine rupture in a large sample of women in Senegal and Mali: cross-sectional analysis of QUARITE trial data. BMC Pregnancy Childbirth 2018; 18:432. [PMID: 30382820 PMCID: PMC6211600 DOI: 10.1186/s12884-018-2064-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/18/2018] [Indexed: 01/27/2023] Open
Abstract
Background The purpose of this study was to investigate predictors of uterine rupture in a large sample of sub-Saharan African women. Uterine rupture is rare in high-income countries, but it is more common in low-income settings where health systems are often under-resourced. However, understanding of risk factors contributing to uterine rupture in such settings is limited due to small sample sizes and research rarely considers system and individual-level factors concomitantly. Methods Cross-sectional data analysis from the pre-intervention period (Oct. 1, 2007- Oct. 1, 2008) of the QUARITE trial, a large-scale maternal mortality study. This research examines uterine rupture among 84,924 women who delivered in one of 46 referral hospitals in Mali and Senegal. A mixed-effects logistic regression model identified individual and geographical risk factors associated with uterine rupture, accounting for clustering by hospital. Results Five hundred sixty-nine incidences of uterine rupture (0.67% of sample) were recorded. Predictors of uterine rupture: grand multiparity defined as > 5 live births (aOR = 7.57, 95%CI; 5.19–11.03), prior cesarean (aOR = 2.02, 95%CI; 1.61–2.54), resides outside hospital region (aOR = 1.90, 95%CI: 1.28–2.81), no prenatal care visits (aOR = 1.80, 95%CI; 1.44–2.25), and birth weight of > 3600 g (aOR = 1.61, 95%CI; 1.30–1.98). Women who were referred and who had an obstructed labor had much higher odds of uterine rupture compared to those who experienced neither (aOR: 46.25, 95%CI; 32.90–65.02). Conclusions The results of this large study confirm that the referral system, particularly for women with obstructed labor and increasing parity, is a main determinant of uterine rupture in this context. Improving labor and delivery management at each level of the health system and communication between health care facilities should be a priority to reduce uterine rupture. Electronic supplementary material The online version of this article (10.1186/s12884-018-2064-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca Delafield
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, 677 Ala Moana Blvd., Suite 1015, Honolulu, HI, 96813-5401, USA.
| | - Catherine M Pirkle
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, BioMed T102, Honolulu, HI, 96822-2319, USA
| | - Alexandre Dumont
- Research Institute for Development, Université Paris Descartes, Sorbonne Paris Cité, Research Unit 196 (CEPED), Paris, France
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Koh VM, Essome H, Sama JD, Foumane P, Ebah BM. [Vaginal birth after previous cesarean section in low-resource countries: healthcare chain and materno-fetal follow-up]. Pan Afr Med J 2018; 30:255. [PMID: 30637040 PMCID: PMC6317296 DOI: 10.11604/pamj.2018.30.255.15678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/11/2018] [Indexed: 12/02/2022] Open
Abstract
The rate of uterine scars, an established risk factor for obstetric morbidity, is increasing worldwide. In developing countries, spontaneous uterine ruptures may constitute 87.4% of cases. Tratment is a problem in modern obstetrics, in particular in these countries. This study aims to describe healthcare chain and materno-fetal follow-up of post-partum women with uterine scar in three university hospitals in the city of Yaoundé in order to highlight morbidity management problems in low-resource countries at the dawn of sustainable development goals. We conducted a cross-sectional descriptive study based on the collection of prospective data over a period of six months in 2014. The study included all consenting post-partum women with uterine scar, having given birth to a gestational at a gestational age greater than or equal to a total of 28 weeks of amenorrhea. The sampling was consecutive and exhaustive. Chi square test statistic was applied in all research areas, with a reliability threshold of p≤ 0.05. Data on 252 women with uterine scars, reflecting a rate of 8% (252/3145), were collected during the study period. Prenatal consultations were performed by inadequate staff in an inadequate sanitary structure in 30% of cases. Women were referred due to delivery complications after first admission to an inadequate sanitary structure in 25% of cases (6 uterine ruptures and 7 dead fetus before admission). There was indication for cesarean section/laparotomy on admission in 39% of cases; the rate of vaginal delivery was of 23%; there was indication for trial of scar in 30% of cases, with a success rate of 76.3%. Vaginal delivery was related to parity, a history of vaginal delivery, fetal macrosomia and was inversely related to the number of scars. Maternal mortality was zero and cesarean section was related to materno-fetal morbidity. The poor quality of prenatal consultations and the management of delivery are the main determinants of problems during vaginal birth after cesarean section in our environment. The establishment of a system facilitating access to skilled health care practitioners/adequate health care facilities for pregnant women with uterine scar would improve the prognosis of post-partum women with uterine scar.
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Affiliation(s)
- Valère Mve Koh
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun
- Centre Hospitalier et Universitaire de Yaoundé, Yaoundé, Cameroun
| | - Henri Essome
- Faculté de Médecine et des Sciences Pharmaceutiques, Université de Douala, Cameroun
| | - Julius Dohbit Sama
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun
- Hôpital Gynéco et Pédiatrique de Yaoundé, Yaoundé, Cameroun
| | - Pascal Foumane
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun
- Hôpital Gynéco et Pédiatrique de Yaoundé, Yaoundé, Cameroun
| | - Bénédicte Mengue Ebah
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun
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Al-Zirqi I, Daltveit AK, Vangen S. Infant outcome after complete uterine rupture. Am J Obstet Gynecol 2018; 219:109.e1-109.e8. [PMID: 29655964 DOI: 10.1016/j.ajog.2018.04.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/03/2018] [Accepted: 04/06/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Complete uterine rupture is a rare peripartum complication often associated with a catastrophic outcome for both mother and child. However, little has been written based on large data sets about maternal and infant outcome after complete ruptures. This is partly due to the rarity of the event and the serious maternal and infant outcome; it is also partly due to the use of international diagnostic codes that do not differentiate between the less catastrophic partial rupture and more catastrophic complete uterine rupture. As uterine rupture is expected to increase due to increased cesarean delivery rates worldwide, it is important to know more completely about the outcome following complete uterine rupture. OBJECTIVE We sought to explore risk factors associated with poor infant outcome in cases of complete uterine rupture. STUDY DESIGN This population-based study used data from the Medical Birth Registry of Norway, the Patient Administration System, and medical records. We included births with complete uterine rupture after start of labor in all maternity units in Norway during the period 1967 through 2008 (n = 244 births), identified among 2,455,797 births. Uterine ruptures were identified and further studied through a review of medical records. We estimated the associations between infant outcomes and demographic and labor risk factors using logistic regression analyses. Odds ratios with 95% confidence intervals for each risk factor were determined after adjustment for demographic factors and period of birth. The main outcome measure was infant outcome: healthy infant, intrapartum/infant deaths, hypoxic ischemic encephalopathy, and admission to the neonatal intensive care unit. RESULTS We identified 109 (44.7%) healthy infants, 56 (23.0%) infants needing neonatal intensive care unit admission, 64 (26.2%) intrapartum/infant deaths, and 15 (6.1%) infants with hypoxic ischemic encephalopathy. The highest number of intrapartum/infant deaths occurred in 1967 through 1977 (51.6%) and the fewest in 2000 through 2008 (15.0%). Unscarred uterine ruptures did not significantly increase intrapartum/infant deaths compared to scarred uterine ruptures. Placental separation and/or fetal extrusion had the highest odds ratio for intrapartum/infant deaths (odds ratio, 17.9; 95% confidence interval, 7.5-42.4). Time-to-delivery interval <20 minutes resulted in fewest intrapartum/infant deaths (9.9%), although there were 2 deaths at 10-minute interval. Time to delivery >30 minutes vs <20 minutes increased risk of death (odds ratio, 16.7; 95% confidence interval, 6.4-43.5). CONCLUSION Intrapartum/infant death after complete uterine rupture decreased significantly over the decades. Time to delivery >30 minutes and placental separation and/or fetal extrusion had the highest association with intrapartum/infant deaths after complete uterine rupture. Time to delivery <20 minutes limited the incidence of intrapartum/infant deaths.
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Rupture of a myomectomy site in the third trimester of pregnancy after myomectomy, septoplasty and cesarean section: A case report. Case Rep Womens Health 2018; 19:e00066. [PMID: 30094194 PMCID: PMC6071369 DOI: 10.1016/j.crwh.2018.e00066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/26/2018] [Accepted: 05/29/2018] [Indexed: 11/21/2022] Open
Abstract
Uterine rupture during pregnancy is a rare but dangerous complication. A history of cesarean section is known to be a risk factor, but other types of uterine surgery can also increase the risk. We report a case of rupture of a myomectomy site in the third trimester of pregnancy without uterine contractions in a woman who had previously undergone myomectomy, septoplasty and cesarean section. The 39-year-old woman (gravida 2, para 2) presented at 29 weeks' gestation with uterine contractions. She was successfully treated with tocolytics. At 32 weeks of pregnancy, in the absence of contractions, the patient complained of severe abdominal pain and she became hypotensive. Emergency laparotomy and cesarean section were performed, resulting in the delivery of a live infant. The myomectomy site was found to have ruptured but the cesarean and septoplasty scars were intact. This case suggests that myomectomy scars are at greater risk of rupture during pregnancy than those resulting from cesarean section and septoplasty. Previous cesarean, septoplasty and myomectomy are risk factors for uterine rupture. The characteristics of uterine rupture depend on the types of surgery the woman has previously undergone. After myomectomy, uterine rupture can occur during pregnancy without contractions. Myomectomy may be a bigger risk factor for uterine rupture than cesarean section.
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Cassidy PR. Care quality following intrauterine death in Spanish hospitals: results from an online survey. BMC Pregnancy Childbirth 2018; 18:22. [PMID: 29321000 PMCID: PMC5763533 DOI: 10.1186/s12884-017-1630-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 12/14/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The objective of the study was to evaluate practices in Spanish hospitals after intrauterine death in terms of medical/ technical care and bereavement support care. METHODS A cross-sectional descriptive study using an online self-completion questionnaire. The population was defined as women who had experienced an intrauterine fetal death between sixteen weeks and birth, either through spontaneous late miscarriage/stillbirth or termination of pregnancy for medical reasons. Respondents were recruited through an online advertisement on a stillbirth charity website and social media. The analysis used Pearson's chi-squared (p ≤ 0.05) test of independence to cross-analyse for associations between objective measures of care quality and independent variables. RESULTS Responses from 796 women were analysed. Half of the women (52.9%) had postmortem contact with their baby. 30.4% left the hospital with a least one linking object or a photograph. In 35.8% of cases parents weren't given any option to recover the body/remains. 22.9% of births ≥26 weeks gestation were by caesarean, with a significant (p < 0.001) difference between public hospitals (16.8%) and private hospitals (41.5%). 29.3% of respondents were not accompanied during the delivery. 48.0% of respondents recalled being administered sedatives at least once during the hospital stay. The autopsy rate in stillbirth cases (≥ 20 weeks) was 70.5% and 44.4% in cases of termination of pregnancy (all gestational ages). Consistent significant (p < 0.05) differences in care practices were found based on gestational age and type of hospital (public or private), but not to other variables related to socio-demographics, pregnancy history or details of the loss/death. Intrauterine deaths at earlier gestational ages received poorer quality care. CONCLUSIONS Supportive healthcare following intrauterine death is important to women's experiences in the hospital and beneficial to the grief process. Many care practices that are standard in other high-income countries are not routine in Spanish hospitals. Providing such care is a relatively new phenomenon in the Spanish health system, the results provide a quality benchmark and identify a number of areas where hospitals could make improvements to care practices that should have important psychosocial benefits for women and their families.
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Affiliation(s)
- Paul Richard Cassidy
- Universidad Complutense de Madrid, Facultad de Ciencia Política y Sociología, Somosaguas, Pozuelo de Alarcon, 28223, Madrid, Spain.
- Umamanita (Stillbirth Charity), C/ Hierbabuena 15, Esc B, 4 Izq, 28039, Madrid, Spain.
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Zharkin N, Prohvatilov S, Burova N, Gavrilchuk T, Snigur G. Fertility-preserving surgery for post-Caesarean uterine scar dehiscence in a pregnant patient. Eur J Obstet Gynecol Reprod Biol 2017; 221:189-190. [PMID: 29246521 DOI: 10.1016/j.ejogrb.2017.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Nikolay Zharkin
- VolSMU, Dept. of Obstetrics and Gynecology, sq. Pavshih Bortcov 1, Volgograd, Russia.
| | - Sergey Prohvatilov
- VolSMU, Dept. of Obstetrics and Gynecology, sq. Pavshih Bortcov 1, Volgograd, Russia
| | - Natalya Burova
- VolSMU, Dept. of Obstetrics and Gynecology, sq. Pavshih Bortcov 1, Volgograd, Russia
| | - Tatiana Gavrilchuk
- VolSMU, Dept. of Obstetrics and Gynecology, sq. Pavshih Bortcov 1, Volgograd, Russia
| | - Grigory Snigur
- VolSMU, Dept. of Obstetrics and Gynecology, sq. Pavshih Bortcov 1, Volgograd, Russia
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Effect of interpregnancy interval on the success rate of trial of labor after cesarean. J Perinatol 2017; 37:1192-1196. [PMID: 29138524 DOI: 10.1038/jp.2017.117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/06/2017] [Accepted: 06/23/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to investigate the association between interpregnancy interval and success of vaginal birth after cesarean. STUDY DESIGN Retrospective 10-year cohort study of pregnant women with one prior cesarean, who opted for trial of labor (n=36 653). Interpregnancy interval is the time between cesarean and next conception. Vaginal birth success rates were compared between six interval groups. Analysis was performed pooled as well as stratified for induction of labor. Adjusted odds ratios were calculated. RESULTS Success rate in the reference group (12 to 24 months) was 72%. Success rates were similar among those with an interval of less than 24 months. Intervals of 24 months or more showed a decrease in success rate; 70% in 24- to 35-month intervals (adjusted odds ratio 0.92 (0.87 to 0.98)), 67% in 36- to 59-month intervals (adjusted odds ratio 0.87 (0.81 to 0.94)) and 62% in intervals of more than 60 months (adjusted odds ratio 0.77 (0.67 to 0.88)). CONCLUSION An interpregnancy interval of <24 months is not associated with a decreased success of vaginal birth after cesarean. Success rates decrease when interval increases.
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de Sá RAM, Pereira de Moraes V, Soares MCDC, Werner H, Ribeiro G, Lopes J, Araujo Júnior E. 3-D Virtual Reconstruction of a Large Amniocele With Protrusion of Legs and Umbilical Cord Following Asymptomatic Uterine Rupture. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:75-77. [PMID: 28760566 DOI: 10.1016/j.jogc.2017.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Complete uterine rupture is a rare and severe intrapartum complication with high rates of maternal and fetal mortality. Asymptomatic uterine rupture is a very rare condition with one unique previous case described in the literature. Three-dimensional virtual models allow an immersive virtual reality of maternal-fetal structures with better understanding by the parents and the medical team. CASE We demonstrate a case of asymptomatic rupture uterine with a large amniocele and protruded legs and umbilical cord at 28 weeks of gestation by using a 3-D virtual model from ultrasound scan data. CONCLUSION 3-D virtual models may be applied to the assessment of obstetric complications, thereby allowing a novel 3-D spatial view of maternal-fetal structures.
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Affiliation(s)
| | | | | | - Heron Werner
- Department of Radiology, Diagnostic Imaging Clinic, Rio de Janeiro, Brazil
| | - Gerson Ribeiro
- Department of Arts and Design, Pontifical Catholic University, Rio de Janeiro, Brazil
| | - Jorge Lopes
- Department of Arts and Design, Pontifical Catholic University, Rio de Janeiro, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
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Affiliation(s)
- Eyal Sheiner
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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