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Wetzler S, Cabrera C, Bernstein PS. Spontaneous uterine rupture complicated by bilateral pulmonary emboli: A case report. Case Rep Womens Health 2024; 42:e00608. [PMID: 38633224 PMCID: PMC11021356 DOI: 10.1016/j.crwh.2024.e00608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
Spontaneous uterine rupture in unscarred uteri complicated by pulmonary emboli is a rare event with major maternal morbidity and mortality. This is a case of a 32-year-old woman, G1P0, at term, with no pertinent past medical/surgical history, who underwent an emergency cesarean delivery for failed induction of labor complicated by uterine rupture. Post-operatively, the patient was tachycardic and hypoxic. CT arteriogram revealed massive bilateral pulmonary emboli, and she was transferred for specialist care. An emergency pulmonary embolectomy and implantation of an extracorporeal right ventricular assist device were performed. Once the patient was clinically stable, an evaluation for thrombophilias and collagen disorders was done, and was positive for a variant of unknown significance in the ELN gene (c.205G > C). This case report highlights a potential connection between uterine ruptures, hemorrhage, and multiple, large pulmonary emboli. The authors propose a multidisciplinary discussion and evaluation to identify risk factors and biologic causes for these rare but life-threatening complications.
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Affiliation(s)
- Sara Wetzler
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
| | - Camila Cabrera
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
| | - Peter S. Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
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Amikam U, Hochberg A, Abramov S, Lavie A, Yogev Y, Hiersch L. Risk factors for maternal complications following uterine rupture: a 12-year single-center experience. Arch Gynecol Obstet 2024; 309:1863-1871. [PMID: 37149828 DOI: 10.1007/s00404-023-07061-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/25/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To determine maternal outcomes and risk factors for composite maternal morbidity following uterine rupture during pregnancy. METHODS A retrospective cohort study including all women diagnosed with uterine rupture during pregnancy, between 2011 and 2023, at a single-center. Patients with partial uterine rupture or dehiscence were excluded. We compared women who had composite maternal morbidity following uterine rupture to those without. Composite maternal morbidity was defined as any of the following: maternal death; hysterectomy; severe postpartum hemorrhage; disseminated intravascular coagulation; injury to adjacent organs; admission to the intensive care unit; or the need for relaparotomy. The primary outcome was risk factors associated with composite maternal morbidity following uterine rupture. The secondary outcome was the incidence of maternal and neonatal complications following uterine rupture. RESULTS During the study period, 147,037 women delivered. Of them, 120 were diagnosed with uterine rupture. Among these, 44 (36.7%) had composite maternal morbidity. There were no cases of maternal death and two cases of neonatal death (1.7%); packed cell transfusion was the major contributor to maternal morbidity [occurring in 36 patients (30%)]. Patients with composite maternal morbidity, compared to those without, were characterized by: increased maternal age (34.7 vs. 32.8 years, p = 0.03); lower gestational age at delivery (35 + 5 vs. 38 + 1 weeks, p = 0.01); a higher rate of unscarred uteri (22.7% vs. 2.6%, p < 0.01); and rupture occurring outside the lower uterine segment (52.3% vs. 10.5%, p < 0.01). CONCLUSION Uterine rupture entails increased risk for several adverse maternal outcomes, though possibly more favorable than previously described. Numerous risk factors for composite maternal morbidity following rupture exist and should be carefully assessed in these patients.
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Affiliation(s)
- Uri Amikam
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Alyssa Hochberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tiqva, Israel
| | - Shani Abramov
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Lavie
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Hiersch
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Ryberg J, Carlsson Y, Svensson M, Thunström E, Svanvik T. Risk of uterine rupture in multiparous women after induction of labor with prostaglandin: A national population-based cohort study. Int J Gynaecol Obstet 2024; 165:328-334. [PMID: 37925605 DOI: 10.1002/ijgo.15208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/22/2023] [Accepted: 10/08/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE To 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. METHODS This 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. RESULTS Overall, 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). CONCLUSION Our 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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Affiliation(s)
- Johanna Ryberg
- Department of Obstetrics and Gynecology, Hallands Sjukhus Halmstad, Halmstad, Sweden
| | - Ylva Carlsson
- Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Svensson
- Department of Mathematics and Computer Science, Faculty of Science, University of Southern Denmark, Odense, Denmark
| | - Erik Thunström
- Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Teresia Svanvik
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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4
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Deshmukh U, Denoble AE, Son M. Trial of labor after cesarean, vaginal birth after cesarean, and the risk of uterine rupture: an expert review. Am J Obstet Gynecol 2024; 230:S783-S803. [PMID: 38462257 DOI: 10.1016/j.ajog.2022.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 03/12/2024]
Abstract
The decision to pursue a trial of labor after cesarean delivery is complex and depends on patient preference, the likelihood of successful vaginal birth after cesarean delivery, assessment of the risks vs benefits of trial of labor after cesarean delivery, and available resources to support safe trial of labor after cesarean delivery at the planned birthing center. The most feared complication of trial of labor after cesarean delivery is uterine rupture, which can have catastrophic consequences, including substantial maternal and perinatal morbidity and mortality. Although the absolute risk of uterine rupture is low, several clinical, historical, obstetrical, and intrapartum factors have been associated with increased risk. It is therefore critical for clinicians managing patients during trial of labor after cesarean delivery to be aware of these risk factors to appropriately select candidates for trial of labor after cesarean delivery and maximize the safety and benefits while minimizing the risks. Caution is advised when considering labor augmentation and induction in patients with a previous cesarean delivery. With established hospital safety protocols that dictate close maternal and fetal monitoring, avoidance of prostaglandins, and careful titration of oxytocin infusion when induction agents are needed, spontaneous and induced trial of labor after cesarean delivery are safe and should be offered to most patients with 1 previous low transverse, low vertical, or unknown uterine incision after appropriate evaluation, counseling, planning, and shared decision-making. Future research should focus on clarifying true risk factors and identifying the optimal approach to intrapartum and induction management, tools for antenatal prediction, and strategies for prevention of uterine rupture during trial of labor after cesarean delivery. A better understanding will facilitate patient counseling, support efforts to improve trial of labor after cesarean delivery and vaginal birth after cesarean delivery rates, and reduce the morbidity and mortality associated with uterine rupture during trial of labor after cesarean delivery.
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Affiliation(s)
- Uma Deshmukh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA
| | - Annalies E Denoble
- Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT
| | - Moeun Son
- Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT.
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Malvasi A, Ballini A, Tinelli A, Fioretti B, Vimercati A, Gliozheni E, Baldini GM, Cascardi E, Dellino M, Bonetti M, Cicinelli E, Vitagliano A, Damiani GR. Oxytocin augmentation and neurotransmitters in prolonged delivery: An experimental appraisal. Eur J Obstet Gynecol Reprod Biol X 2024; 21:100273. [PMID: 38274243 PMCID: PMC10809121 DOI: 10.1016/j.eurox.2023.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
The uterus is a highly innervated organ, and during labor, this innervation is at its highest level. Oxytocinergic fibers play an important role in labor and delivery and, in particular, the Lower Uterine Segment, cervix, and fundus are all controlled by motor neurofibers. Oxytocin is a neurohormone that acts on receptors located on the membrane of the smooth cells of the myometrium. During the stages of labor and delivery, its binding causes myofibers to contract, which enables the fundus of the uterus to act as a mediator. The aim of this study was to investigate the presence of oxytocinergic fibers in prolonged and non-prolonged dystocic delivery in a cohort of 90 patients, evaluated during the first and second stages of labor. Myometrial tissue samples were collected and evaluated by electron microscopy, in order to quantify differences in neurofibers concentrations between the investigated and control cohorts of patients. The authors of this experiment showed that the concentration of oxytocinergic fibers differs between non-prolonged and prolonged dystocic delivery. In particular, in prolonged dystocic delivery, compared to non-prolonged dystocic delivery, there is a lower amount of oxytocin fiber. The increase in oxytocin appeared to be ineffective in patients who experienced prolonged dystocic delivery, since the dystocic labor ended as a result of the altered presence of oxytocinergic fibers detected in this group of patients.
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Affiliation(s)
- Antonio Malvasi
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Andrea Ballini
- Department of clinical and experimental medicine, University of Foggia, Foggia, 71122, Italy
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology and CERICSAL (CEntro di RIcerca Clinico SALentino), Veris Delli Ponti Hospital, 73020 Scorrano, Italy
| | - Bernard Fioretti
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Via dell'Elce di Sotto 8, 06132 Perugia, Italy
| | - Antonella Vimercati
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Elko Gliozheni
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy
- University of Medicine of Tirana, Department of Obstetrics and Gynecology, Tirana, Albania
| | - Giorgio Maria Baldini
- Momo Fertilife, IVF Clinic, Bisceglie, 76011, Italy
- University of Bari Aldo Moro, 70121, Bari, Italy
| | - Eliano Cascardi
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Miriam Dellino
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Monica Bonetti
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Ettore Cicinelli
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Amerigo Vitagliano
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Gianluca Raffaello Damiani
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
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Rahman L, Praharsini K, Januajie A, Anwar R. Labisia pumila as a Culprit of Primary Uterine Rupture Alongside Abruptio Placentae: A Case Report. Int Med Case Rep J 2024; 17:51-55. [PMID: 38283596 PMCID: PMC10812690 DOI: 10.2147/imcrj.s442687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024] Open
Abstract
Purpose Uterine rupture is a rare obstetrical and surgical emergency but is often associated with a catastrophic obstetric complication. Traditionally, unscarred uteri without risk factors are considered immune to rupture and information about its risk factors is only few due to its rarity. Complementary and alternative medicine is commonly used in pregnant woman in southeast Asian countries such as Indonesia, however information regarding its toxicity due to irrational use is few. This case report presents a G2P1A0 35-year-old woman with acute abdomen with spontaneous unscarred uterine rupture >15 cm after continuously consuming herbal water made of Kacip Fatimah leaves in boiling water. Case Description A 35-year-old pregnant woman was referred to hospital due to abdominal discomfort 3 hours before admission due to suspicion of intrauterine fetal death. She drank the extracted herbal water to help her when the labor comes, which was made from boiled water with rumput Fatimah from her neighbor's house. Then, she was diagnosed with G2P1A0 parturient aterm latent phase; acute abdomen due to suspicion of placentae abruption dd/ ruptur uteri; and Intrauterine Fetal Death. Exploratory laparotomy was decided due to acute abdominal pain, and during the procedure the operator decided to do subtotal hysterectomy on the patient. The operator found her uterine was already ruptured, approximately 15-18 cm and the placentae was located outside of the uterus. Conclusion This case suggest that rational usage of herbal medicine must be implemented to avoid unwanted complication.
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Affiliation(s)
- Luthfi Rahman
- Department of Obstetrics and Gynecology, Hasan Sadikin General Hospital-Padjadjaran University, Bandung, Indonesia
| | - Kania Praharsini
- Department of Obstetrics and Gynecology, Hasan Sadikin General Hospital-Padjadjaran University, Bandung, Indonesia
| | - Aditiyo Januajie
- Department of Obstetrics and Gynecology, Hasan Sadikin General Hospital-Padjadjaran University, Bandung, Indonesia
| | - Ruswana Anwar
- Department of Obstetrics and Gynecology, Hasan Sadikin General Hospital-Padjadjaran University, Bandung, Indonesia
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Phillips JM, Polyakov D, Amdur RL, Ahmadzia HK. Trial of labor after cesarean: Maternal and neonatal outcomes from the Consortium on Safe Labor. J Neonatal Perinatal Med 2024; 17:1-5. [PMID: 38393923 DOI: 10.3233/npm-230009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
BACKGROUND The aim of our study is to describe maternal and neonatal morbidity and mortality in patients undergoing trial of labor after cesarean from the Consortium on Safe Labor. METHODS This was a secondary analysis of the Consortium on Safe Labor database, a retrospective cohort study over a 7 year study period. Maternal and neonatal outcomes were evaluated based on desired delivery mode: planned elective repeat cesarean delivery or trial of labor after cesarean. RESULTS Of 9858 patients in our analysis, our study population had 4400 patients (45%) who desired trial of labor after cesarean and 5458 patients (55%) who desired elective repeat cesarean delivery. Women who attempted trial of labor after cesarean compared to those who had an elective repeat cesarean delivery were more likely to have an obstetric hemorrhage (adjusted odds ratio 1.6; 95% CI 1.3 -2.0) and blood transfusion (adjusted odds ratio 2.3; 95% CI 1.6 -3.2). CONCLUSION Maternal morbidity in women undergoing trial of labor after cesarean was predominantly hemorrhage-related.
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Affiliation(s)
- J M Phillips
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - D Polyakov
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - R L Amdur
- Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - H K Ahmadzia
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Wada N, Tamate M, Matsuura M, Saito T. Diagnosis and Methods of Repair for a Uteroperitoneal Fistula (UPF) Formed After Gynecological Surgeries. Cureus 2023; 15:e51064. [PMID: 38146339 PMCID: PMC10749506 DOI: 10.7759/cureus.51064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2023] [Indexed: 12/27/2023] Open
Abstract
A uteroperitoneal fistula (UPF) is a rare disorder that can lead to infertility and has never been reported. UPFs can cause infertility and perinatal complications. A 34-year-old woman (gravida 0) with a history of three gynecological surgeries using a uterine manipulator was diagnosed with a UPF using hysteroscopy and hysterosalpingography. She underwent laparoscopic uterine repair as an infertility treatment. The uterine perforation may have been caused by uterine manipulator insertion or suture failure in the myometrium during her previous laparoscopic myomectomy and cystectomy procedures. The UPF disappeared after the current surgical treatment. The complications of UPFs include infection, infertility, ectopic pregnancy, and uterine rupture. We expected that the presence of a fistula would increase the risk of impaired fertilization, implantation failure, and ectopic pregnancy. This case report contributes valuable insights into the diagnosis of UPFs and their laparoscopic repair.
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Affiliation(s)
- Nagisa Wada
- Obstetrics and Gynecology, Sapporo Medical University, Sapporo, JPN
| | - Masato Tamate
- Obstetrics and Gynecology, Sapporo Medical University, Sapporo, JPN
| | - Motoki Matsuura
- Obstetrics and Gynecology, Sapporo Medical University, Sapporo, JPN
| | - Tsuyoshi Saito
- Obstetrics and Gynecology, Sapporo Medical University, Sapporo, JPN
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Liao YC, Tsang LLC, Yang TH, Lin YJ, Chang YW, Hsu TY, Kung FT. Unscarred uterine rupture with catastrophic hemorrhage immediately after vaginal delivery: diagnosis and management of six consecutive cases. J Matern Fetal Neonatal Med 2023; 36:2243366. [PMID: 37586890 DOI: 10.1080/14767058.2023.2243366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND To describe and explore the risk factors, clinical presentations, timely diagnostic approaches, and management in patients experiencing unscarred uterine rupture with catastrophic hemorrhage. METHODS We retrospectively analyzed clinical and imaging data from women who encountered postpartum hemorrhage (PPH) and were diagnosed with unscarred uterine rupture within a three-year timeframe (2018-2020). The data were extracted from medical records obtained from a multi-hospital 24-hour emergency PPH transfer system. RESULTS Six patients were identified as having unscarred uterine rupture after vaginal delivery. All six women were para 2, with four of them undergoing vacuum-assisted delivery. One patient experienced out-of-hospital cardiac arrest (OHCA), while five patients presented with hypovolemic shock. Abdominopelvic ultrasound revealed a boggy lower uterine segment. Initially, five patients underwent transarterial embolization (TAE) of the internal iliac arteries in an attempt to achieve hemostasis, but this approach proved unsuccessful. Abdominopelvic computed tomography (CT) confirmed the diagnosis of ruptured uterus by demonstrating disrupted myometrium and hemoperitoneum. Immediate exploratory laparotomy followed by life-saving hysterectomy was performed in all cases. The median estimated total blood loss was 2725 mL ± 900 mL (ranging from 1600 mL to 7100 mL). Lower segment lacerations were observed in all patients, with more extensive uterine damage noted in those who underwent vacuum extraction. The length of hospital stay varied between 9 and 38 days. CONCLUSION Instrument-assisted obstetric delivery is a possible contributing factor to unscarred uterine rupture in our study. In specific cases, the use of abdominopelvic CT prior to initiating transarterial embolization (TAE) offers valuable information to complement ultrasound findings. This comprehensive approach helps in accurately identifying the underlying cause of intractable postpartum hemorrhage (PPH). Immediate conversion to laparotomy is essential to explore the intra-abdominal factors causing PPH that cannot be controlled by TAE. The rational etiologies of uterine rupture must be clarified while generating practical guideline in the future.
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Affiliation(s)
- Yi-Chiao Liao
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Leo Leung-Chit Tsang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsai-Hwa Yang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Ju Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Wei Chang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Te-Yao Hsu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Tsai Kung
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Obstetrics and Gynecology, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
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10
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Sugai S, Yamawaki K, Haino K, Yoshihara K, Nishijima K. Incidence of Recurrent Uterine Rupture: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 142:1365-1372. [PMID: 37884008 PMCID: PMC10642701 DOI: 10.1097/aog.0000000000005418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE We aimed to quantify the incidence of recurrent uterine rupture in pregnant women. DATA SOURCES A literature search of PubMed, Web of Science, Cochrane Central, and ClinicalTrials.gov for observational studies was performed from 2000 to 2023. METHODS OF STUDY SELECTION Of the 7,440 articles screened, 13 studies were included in the final review. We included studies of previous uterine ruptures that were complete uterine ruptures , defined as destruction of all uterine layers, including the serosa. The primary outcome was the pooled incidence of recurrent uterine rupture. Between-study heterogeneity was assessed with the I2 value. Subgroup analyses were conducted in terms of the country development status, year of publication, and study size (single center vs national study). The secondary outcomes comprised the following: 1) mean gestational age at which recurrent rupture occurred, 2) mean gestational age at which delivery occurred without recurrent rupture, and 3) perinatal complications (blood loss, transfusion, maternal mortality, and neonatal mortality). TABULATION, INTEGRATION, AND RESULTS A random-effects model was used to pool the incidence or mean value and the corresponding 95% CI with R software. The pooled incidence of recurrent uterine rupture was 10% (95% CI 6-17%). Developed countries had a significantly lower uterine rupture recurrence rate than less developed countries (6% vs 15%, P =.04). Year of publication and study size were not significantly associated with recurrent uterine rupture. The mean number of gestational weeks at the time of recurrent uterine rupture was 32.49 (95% CI 29.90-35.08). The mean number of gestational weeks at the time of delivery without recurrent uterine rupture was 35.77 (95% CI 34.95-36.60). The maternal mortality rate was 5% (95% CI 2-11%), and the neonatal mortality rate was 5% (95% CI 3-10%). Morbidity from hemorrhage, such as bleeding and transfusion, was not reported in any study and could not be evaluated. CONCLUSION This systematic review estimated a 10% incidence of recurrent uterine rupture. This finding will enable appropriate risk counseling in patients with prior uterine rupture. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42023395010.
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Affiliation(s)
- Shunya Sugai
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
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11
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Ukah UV, Platt RW, Auger N, Lisonkova S, Ray JG, Malhamé I, Ayoub A, El-Chaâr D, Dayan N. Risk of recurrent severe maternal morbidity: a population-based study. Am J Obstet Gynecol 2023; 229:545.e1-545.e11. [PMID: 37301530 DOI: 10.1016/j.ajog.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/24/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Severe maternal morbidity is a composite indicator of maternal health and obstetrical care. Little is known about the risk of recurrent severe maternal morbidity in a subsequent delivery. OBJECTIVE This study aimed to estimate the risk of recurrent severe maternal morbidity in the next delivery after a complicated first delivery. STUDY DESIGN We analyzed a population-based cohort study of women with at least 2 singleton hospital deliveries between 1989 and 2021 in Quebec, Canada. The exposure was severe maternal morbidity in the first hospital-recorded delivery. The study outcome was severe maternal morbidity at the second delivery. Log-binomial regression models adjusted for maternal and pregnancy characteristics were used to generate relative risks and 95% confidence intervals comparing women with and without severe maternal morbidity at first delivery. RESULTS Among 819,375 women, 43,501 (3.2%) experienced severe maternal morbidity in the first delivery. The rate of severe maternal morbidity recurrence at second delivery was 65.2 vs 20.3 per 1000 in women with and without previous severe maternal morbidity (adjusted relative risk, 3.11; 95% confidence interval, 2.96-3.27). The adjusted relative risk for recurrence of severe maternal morbidity was greatest among women who had ≥3 different types of severe maternal morbidity at their first delivery, relative to those with none (adjusted relative risk, 5.50; 95% confidence interval, 4.26-7.10). Women with cardiac complication at first delivery had the highest risk of severe maternal morbidity in the next delivery. CONCLUSION Women who experience severe maternal morbidity have a relatively high risk of recurrent morbidity in the subsequent pregnancy. In women with severe maternal morbidity, these study findings have implications for prepregnancy counseling and maternity care in the next pregnancy.
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Affiliation(s)
- Ugochinyere Vivian Ukah
- Institut national de santé publique du Québec, Montreal, Canada; HealthPartners Institute, Pregnancy and Child Health Research Center, Bloomington, MN; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Robert W Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Nathalie Auger
- Institut national de santé publique du Québec, Montreal, Canada
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology and the BC Children's and Women's Hospital, The University of British Columbia, Vancouver, Canada
| | - Joel G Ray
- Department of Medicine and the Institute of Health Policy and Evaluation, University of Toronto, Toronto, Canada
| | - Isabelle Malhamé
- Department of Medicine, McGill University Health Centre, Montreal, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Aimina Ayoub
- Institut national de santé publique du Québec, Montreal, Canada
| | - Darine El-Chaâr
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
| | - Natalie Dayan
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada; Department of Medicine, McGill University Health Centre, Montreal, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada.
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12
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Arusi TT, Zewdu Assefa D, Gutulo MG, Gensa Geta T. Predictors of Uterine Rupture After One Previous Cesarean Section: An Unmatched Case-Control Study. Int J Womens Health 2023; 15:1491-1500. [PMID: 37814706 PMCID: PMC10560464 DOI: 10.2147/ijwh.s427749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/26/2023] [Indexed: 10/11/2023] Open
Abstract
Background Uterine rupture is a rare occurrence but has catastrophic complications during pregnancy. The incidence is relatively higher in scarred uteri because there is a promotion of labor after cesarean section. There is a scarcity of evidence from low-income countries regarding the predictors of uterine rupture after trial labor. Objective To assess factors determining uterine rupture during labor after the previous cesarean section among mothers delivered at Hawassa University Comprehensive Specialized Hospital from September 2017 to September 2022. Methods A facility-based unmatched case-control study was done by reviewing 105 patients, which included 35 cases and 70 controls in a 1:2 case-to-control ratio. The association between dependent and independent variables was sought with running binary and multivariate analyses by using the cut point of a p value < 0.05 and 95% CI. Results The prevalence of uterine rupture is 1.6%. The factors significantly associated with uterine rupture after trial of labor are fetal weight >3.8 kg (AOR: 5.21), antenatal care 4 (AOR: 3.6), labor duration >15 hours (AOR: 10.7), and previous successful vaginal delivery (AOR: 3.4). Poor fetal-maternal outcomes like 91.4% fetal death, 29 hysterectomies, 22 blood transfusions, and 1 death. Conclusion The prevalence is relatively higher than in developed countries. The number of antenatal care, labor duration, and lower fetal weight are not common findings associated with uterine rupture after trial of labor across the literature, so large-scale studies are needed to develop guidelines for the Ethiopian setup. Improving the quality of obstetrics care given in each level of health system.
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Affiliation(s)
- Temesgen Tantu Arusi
- Department of Obstetrics and Gynecology, Wolkite University College of Health Science, Wolkite, Ethiopia
- Department of Obstetrics and Gynecology, Hawassa University, Hawassa City, Ethiopia
| | - Dereje Zewdu Assefa
- Department of Anesthesia, Wolkite University College of Medicine and Health Sciences, Wolkite, Ethiopia
| | - Muluken Gunta Gutulo
- Wolaita Zone Health Department, Wolaita Zone Health Bureau, Wolaita Sodo, Ethiopia
| | - Teshome Gensa Geta
- Department of Public Health, Wolkite University College of Health Science, Wolkite, Ethiopia
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13
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Nardi E, Seravalli V, Abati I, Castiglione F, Di Tommaso M. Antepartum unscarred uterine rupture caused by placenta percreta: a case report and literature review. Pathologica 2023; 115:232-236. [PMID: 37711040 PMCID: PMC10688248 DOI: 10.32074/1591-951x-882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 09/16/2023] Open
Abstract
The main risk for uterine rupture is the presence of a uterine scar due to prior cesarean delivery or other uterine surgery. However, rupture in an unscarred uterus is extremely rare, and risk factors include multiple gestations, trauma, congenital anomalies, use of uterotonics and placenta accreta spectrum. Placenta accreta spectrum, also known as morbidly adherent placenta, is becoming increasingly common and is associated with significant maternal and neonatal morbidity and mortality. We report a case of unscarred uterine rupture due to placenta percreta in a multiparous woman that required emergency peripartum hysterectomy.
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Affiliation(s)
- Eleonora Nardi
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Viola Seravalli
- Department of Health Science, Division of Obstetrics & Gynecology, University of Florence, Florence, Italy
| | - Isabella Abati
- Department of Health Science, Division of Obstetrics & Gynecology, University of Florence, Florence, Italy
| | - Francesca Castiglione
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Mariarosaria Di Tommaso
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
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14
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Mehl ST, Simmons PM, Whittington JR, Escalona-Vargas D, Siegel ER, Lowery CL, Crimmins-Pierce LD, Eswaran H. Assessing uterine electrophysiology prior to elective term induction of labor. Curr Res Physiol 2023; 6:100103. [PMID: 37554388 PMCID: PMC10404855 DOI: 10.1016/j.crphys.2023.100103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/07/2023] [Accepted: 07/20/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE The purpose of this study was to determine if uterine electrophysiological signals gathered from 151 non-invasive biomagnetic sensors spread over the abdomen were associated with successful induction of labor (IOL). STUDY DESIGN Uterine magnetomyogram (MMG) signals were collected using the SARA (SQUID Array for Reproductive Assessment) device from 33 subjects between 37 and 42 weeks gestational age. The signals were post-processed, uterine contractile related MMG bursts were detected, and parameters in the time and frequency domain were extracted. The modified Bishop score calculated at admission was used to determine the method of IOL. Wilcoxon's rank-sum test was used to compare IOL successes and failures for differences in gestational age (GA), parity, modified Bishop's score, maximum oxytocin, and electrophysiological parameters extracted from MMG. RESULTS The average parity was three times (3x) higher (1.53 versus 0.50; p = 0.039), and the average modified Bishop score was 2x higher (3.32 versus 1.63; p = 0.032) amongst IOL successes than failures, while the average GA and maximum oxytocin showed a small difference. For the MMG parameters, successful IOLs had, on average, 3.5x greater mean power during bursts (0.246 versus 0.070; p = 0.034) and approximately 1.2x greater mean number of bursts (2.05 versus 1.68; p = 0.036) compared to the failed IOLs, but non-significant differences were observed in mean peak frequency, mean burst duration, and mean duration between bursts. CONCLUSION The study showed that inductions of labor that took less than 24 h to deliver have a higher mean power in the baseline electrophysiological activity of the uterus when recorded prior to planned induction. The results are indicative that baseline electrophysiological activity measured prior to induction is associated with successful induction.
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Affiliation(s)
- Sarah T. Mehl
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center, Houston, TX, USA
| | - Pamela M. Simmons
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Julie R. Whittington
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Obstetrics and Gynecology, Naval Medical Center, Portsmouth, VA, USA
| | - Diana Escalona-Vargas
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Eric R. Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Curtis L. Lowery
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lauren D. Crimmins-Pierce
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hari Eswaran
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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15
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Mansoux L, Lejeune-Saada V, Dupuis N, Guerby P. [Uterine rupture during medical termination of pregnancy or intrauterine death: A risk management study]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:331-336. [PMID: 36931596 DOI: 10.1016/j.gofs.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/01/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE To describe and analyze a series of uterine ruptures (UR) that occurred in the context of medical termination of pregnancy (MTP) or intrauterine death (IUD) from a risk management perspective. METHODS French retrospective descriptive observational study of all cases of UR occurring during induction for IUD or MTP, reported between 2011 and 2021 by Gynerisq. Cases were recorded on a basis of voluntary reports using targeted questionnaires. RESULTS Between November 27, 2011, and August 22, 2021, 12 cases of UR occurring during an induction for IUD or MTP were recorded. 50 % of the patients had never given birth by cesarean section. The term of delivery varied from 17+3 days to 41+2 days. The clinical signs found were pain (n=6), ascending fetal presentation (n=5) and bleeding (n=4). All patients were managed by laparotomy, 5 were transfused. One vascular ligation and one hysterectomy were required. CONCLUSION Knowledge of surgical history is involved in the prevention of UR. The signs of detection are pain, ascending presentation and bleeding. The speed of management and good teamwork allow a reduction of maternal complications. The findings of the morbidity and mortality reviews show that prevention and mitigation barriers can be established.
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Affiliation(s)
- Lucile Mansoux
- CHU Toulouse, Pôle Femme Mère Couple, hôpital Paule de Viguier, 31059 Toulouse, France; Université Paul Sabatier Toulouse III, 31330 Toulouse, France.
| | | | - Ninon Dupuis
- CHU Toulouse, Pôle Femme Mère Couple, hôpital Paule de Viguier, 31059 Toulouse, France; Université Paul Sabatier Toulouse III, 31330 Toulouse, France
| | - Paul Guerby
- CHU Toulouse, Pôle Femme Mère Couple, hôpital Paule de Viguier, 31059 Toulouse, France; Université Paul Sabatier Toulouse III, 31330 Toulouse, France
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16
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Pregnancies in Women with a Previous Complete Uterine Rupture. Obstet Gynecol Int 2023; 2023:9056489. [PMID: 36819713 PMCID: PMC9935781 DOI: 10.1155/2023/9056489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/04/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
Objective To study the outcomes of new pregnancies after a previous complete uterine rupture. Design Descriptive study based on population data from the Medical Birth Registry of Norway, the Patient Administration System, and the medical records. Sample. Maternities with a previous complete uterine rupture in Norway during the period 1967-2011 (N = 72), extracted from 2 455 797 maternities. Method We measured the rate of new complete ruptures and partial ruptures, as well as the maternal and perinatal outcomes of these pregnancies. The characteristics of both previous ruptures and new ruptures were described. Results Among 72 maternities, there were thirty-seven with previous ruptures in the lower segment (LS) and 35 outside the LS. We found three new complete ruptures and six uneventful partial ruptures, resulting in a rate of 4.2% and 8.3%, respectively. All three complete ruptures occurred preterm in scars outside the LS. The rate of the new complete rupture was 0% in those with previous ruptures in the LS and 8.6% in those with previous ruptures outside the LS. The corrected perinatal mortality was 1.3%, and prematurity (<37 weeks) was high (36.1%); this was noticed even in the absence of new ruptures and was mostly iatrogenic. Two hysterectomies were performed in the absence of rupture and two cases had abnormal invasive placenta. Conclusion The prognosis for pregnancies after a previous complete uterine rupture is favorable. Prematurity is a problem caused by both obstetrician and mother's anxiety; therefore, the timing of delivery is the most challenging. Management should include careful counseling, vigilance for symptoms, and immediate delivery when a rupture is suspected.
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17
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Levin G, Tsur A, Burke YZ, Meyer R. Methods of induction of labor after cesarean with no prior vaginal delivery-Perinatal outcomes. Int J Gynaecol Obstet 2023; 160:612-619. [PMID: 35751576 PMCID: PMC10084373 DOI: 10.1002/ijgo.14318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/01/2022] [Accepted: 06/20/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To study the association between the method of induction of labor (IOL) and perinatal outcomes, among women undergoing labor after cesarean (LAC) with no prior vaginal delivery. METHOD A retrospective study including all women with no prior vaginal delivery undergoing IOL for LAC between March 2011 and January 2021. Oxytocin administration following prelabor rupture of membranes (PROM), oxytocin administration only, extra-amniotic balloon, and amniotomy were compared. RESULTS Overall, 363 women met the inclusion criteria: extra-amniotic balloon (157, 43.3%), oxytocin following PROM (95, 26.2%), amniotomy (72, 19.8%), and oxytocin (39, 10.7%). LAC success rate did not differ among study groups (P = 0.114), varying between 62.1% and 79.5%. There were three uterine ruptures (0.8%) in the entire cohort. The rate of uterine rupture, postpartum hemorrhage, and the composite of both were similar in all study groups. Neonatal outcomes did not differ between study groups, with composite adverse neonatal outcomes varying between 7.4% in the oxytocin following PROM to 1.9% in the extra-amniotic balloon group (P = 0.141). The following factors were independently associated with LAC success: taller maternal height, lower body mass index, earlier gestational age, and epidural analgesia. CONCLUSIONS All examined IOL methods with an unfavorable cervix carried similar outcomes. The clinical practice should be individualized.
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Affiliation(s)
- Gabriel Levin
- The Department of Gynecologic Oncology, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Abraham Tsur
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel
| | - Yechiel Z Burke
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel.,The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat-Gan, Israel
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18
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Feleke G, Tantu T, Zewdu D, Gedefawu A, Wondosen M, Gunta M. Case-control study on determinants of uterine rupture among mothers who gave birth at Hawassa University comprehensive specialized hospital. PLoS One 2023; 18:e0279175. [PMID: 36638128 PMCID: PMC9838871 DOI: 10.1371/journal.pone.0279175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/01/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Uterine rupture is defined as tearing of the uterine wall during pregnancy or delivery. It can occur during pregnancy or labor and delivery. Rupture of the uterus is a catastrophic event resulting in the death of the baby, and severe maternal morbidity and mortality Despite different interventions done by stakeholders, it remained one of the leading public problems in developing countries like Ethiopia. OBJECTIVE This study assessed the prevalence and determinants of uterine rupture among mothers who gave birth at Hawassa University comprehensive specialized hospital from July 2015 to June 2020G.C. METHOD A case-control study was conducted by reviewing data from a total of 582 patient charts which include 194 cases and 388 controls with a case-to-control ratio of 1:2. Then the data was extracted using a pre-tested and structured data extraction sheet. Data were entered using Epi data 3.1 and exported to SPSS and analyzed using SPSS 20. The association between independent variables and uterine rupture was estimated using an odds ratio with 95% confidence intervals. The statistical significance of the association was declared at P-value < 0.05. RESULT There were a total of 22,586 deliveries and 247 confirmed cases of uterine rupture which makes the prevalence 1.09%. Lack of ANC (Ante-natal care) (AOR = 7.5; 95% CI: 1.9-30.3) inadequate ANC (AOR = 2.45; 95% CI: 1.1-5.57), gravidity ≥5 (AOR = 3.3; 95% CI: 1.36-8.12), obstructed labor (AOR = 38.3; 95% CI: 17.8-82.4) and fetal macrosomia (AOR = 8; 95% CI: 17.8-82.4) are variables which increase the odds of developing uterine rupture. Mothers without additional medical or obstetric conditions are more likely (AOR = 4.2; 95% CI: 2.1-8.65) to develop uterine rupture than mothers with additional medical or obstetric conditions. CONCLUSION The prevalence of uterine rupture is high in the study area. The study also revealed that a decrease in ANC follow-up, gravidity of ≥5, obstructed labor, and fetal weight of >4kg are significantly associated with uterine rupture. Improving the quality of ANC follow-up, intrapartum follow-up and proper estimation of fetal weight are recommended interventions from the study.
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Affiliation(s)
- Getnet Feleke
- Obstetrics and Gynecology in Arbaminch University College of Medicine and Health Sciences, Arbaminch, Ethiopia
| | - Temesgen Tantu
- Obstetrics and Gynecology in Wolkite University College of Medicine and Health Sciences, Wolkite, Ethiopia
- * E-mail:
| | - Dereje Zewdu
- Anesthesia in Wolkite University College of Medicine and Health Sciences, Wolkite, Ethiopia
| | - Abel Gedefawu
- Obstetrics and Gynecology in Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Mekete Wondosen
- Surgery in Wolkite University College of Medicine and Health Sciences, Wolkite, Ethiopia
| | - Muluken Gunta
- MPH, Wolaita Zone Health Department, Wolaita Sodo, Ethiopia
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19
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Williams FB, Pierce H, McBride CA, DeAngelis J, McLean K. Quality Initiative to Reduce Failed Trial of Labor after Cesarean Using Calculated VBAC Success Likelihood. Am J Perinatol 2022; 40:575-581. [PMID: 36228652 DOI: 10.1055/a-1960-2797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Vaginal birth after cesarean can reduce morbidity associated with multiple cesarean deliveries. Failed vaginal birth after cesarean is associated with increased maternal and neonatal morbidity. The Maternal-Fetal Medicine Units Vaginal Birth After Cesarean calculator is a validated tool to predict the likelihood of successful trial of labor after cesarean. Predicted likelihood < 60% has been associated with increased maternal and neonatal morbidity. We sought to determine if formal incorporation of calculated vaginal birth after cesarean likelihood into patient-centered counseling would reduce failed vaginal birth after cesarean. STUDY DESIGN This is a quality improvement intervention at a single tertiary-care academic medical center, in which standardized patient counseling was implemented, facilitated by an electronic medical record template featuring patient-specific likelihood of vaginal birth after cesarean success. Term singleton pregnancies with history of one to two cesareans were included; those with contraindication to labor were excluded. Historical controls (January 2016-December 2018, n = 693) were compared with a postimplementation cohort (January 2019-April 2020, n = 328). Primary outcome was failed vaginal birth after cesarean. RESULTS Fewer patients in the postintervention cohort had a history of an arrest disorder (PRE: 48%, 330/693 vs. POST: 40%, 130/326, p = 0.03); demographics were otherwise similar, including the proportion of patients with <60% likelihood of success (PRE: 39%, 267/693, vs. POST: 38%, 125/326). Following implementation, induction of labor in patients with a <60% likelihood of successful vaginal birth after cesarean decreased from 17% (45/267) to 5% (6/125, p < 0.01). The proportion of failed vaginal birth after cesarean decreased from 33% (107/329) to 22% (32/143, p = 0.04). Overall vaginal birth after cesarean rate did not change (PRE: 32%, 222/693, vs. POST: 34%, 111/326, p = 0.52). CONCLUSION An intervention targeting provider counseling that included a validated vaginal birth after cesarean success likelihood was associated with decreased risk of failed trial of labor after cesarean without affecting overall vaginal birth after cesarean rate. KEY POINTS · Labored cesarean increases maternal morbidity.. · Application of the Maternal-Fetal Medicine Units (MFMU) calculator to antenatal counseling decreased labored cesarean.. · Application of the MFMU calculator to antenatal counseling did not decrease overall vaginal birth after cesarean rate..
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Affiliation(s)
- Frank B Williams
- Department of Obstetrics, Gynecology and Reproductive Services, University of Vermont, Burlington, Vermont
| | - Hayley Pierce
- Department of Obstetrics, Gynecology and Reproductive Services, University of Vermont, Burlington, Vermont
| | - Carole A McBride
- Department of Obstetrics, Gynecology and Reproductive Services, University of Vermont, Burlington, Vermont
| | - Justin DeAngelis
- Department of Obstetrics, Gynecology and Reproductive Services, University of Vermont, Burlington, Vermont
| | - Kelley McLean
- Department of Obstetrics, Gynecology and Reproductive Services, University of Vermont, Burlington, Vermont
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20
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Koshimizu K, Kakogawa J, Murata S, Suzuki M, Suzuki T, Masaoka N. Uterine rupture in the third trimester of a pregnancy subsequent to a cesarean section by transverse uterine fundal incision: A case report and literature review. Clin Case Rep 2022; 10:e6752. [PMCID: PMC9748222 DOI: 10.1002/ccr3.6752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/20/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022] Open
Abstract
Cesarean section via a transverse uterine fundal incision is performed in patients with placenta previa to reduce blood loss. We describe a case of uterine rupture in a pregnant woman who previously underwent a cesarean section and recovered from cardiac arrest by multidisciplinary management.
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Affiliation(s)
- Kei Koshimizu
- Department of Obstetrics and GynecologyTokyo Women's Medical UniversityTokyoJapan
| | - Jun Kakogawa
- Department of Obstetrics and GynecologyTokyo Women's Medical UniversityTokyoJapan
| | - Shuko Murata
- Department of Obstetrics and GynecologyTokyo Women's Medical UniversityTokyoJapan
| | - Masato Suzuki
- Department of Obstetrics and GynecologyTokyo Women's Medical UniversityTokyoJapan
| | - Takashi Suzuki
- Department of Obstetrics and GynecologyTokyo Women's Medical UniversityTokyoJapan
| | - Naoki Masaoka
- Department of Obstetrics and GynecologyTokyo Women's Medical UniversityTokyoJapan
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21
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Haavaldsen C, Morken N, Saugstad OD, Eskild A. Is the increasing prevalence of labor induction accompanied by changes in pregnancy outcomes? An observational study of all singleton births at gestational weeks 37-42 in Norway during 1999-2019. Acta Obstet Gynecol Scand 2022; 102:158-173. [PMID: 36495002 PMCID: PMC9889324 DOI: 10.1111/aogs.14489] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/07/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Induction of labor is often performed to prevent adverse perinatal and maternal outcomes, and has become increasingly common. We studied whether changes in prevalence of labor induction in gestational weeks 37-42 weeks were accompanied by changes in adverse pregnancy outcomes or mode of delivery. MATERIAL AND METHODS We used data from the Medical Birth Registry of Norway, and included all singleton births in gestational weeks 37-42 in Norway, 1999-2019 (n = 1 127 945). We calculated the prevalence of labor induction and outcome measures according to year of birth. We repeated these calculations for each gestational week at birth. RESULTS The prevalence of labor induction increased from 9.7% to 25.9%, and the increase was particularly high in gestational week 41. A modest decline in fetal deaths was observed in all gestational weeks, except gestational week 41. The overall decline was from 0.18% in 1999-2004 to 0.13% during 2015-2019. There were no overall changes in other perinatal outcomes. The prevalence of postpartum hemorrhage ≥500 ml increased from 11.4% in 1999 to 30.1% in 2019, and operative deliveries increased slightly. The prevalence of acute cesarean section increased from 6.5% to 9.3%, whereas vacuum and/or forceps assisted deliveries increased from 7.8% to 10.4%. CONCLUSIONS A high increase in labor inductions was accompanied by a modest decline in fetal deaths, but no decline in other adverse perinatal outcomes. In settings where the prevalence of adverse perinatal outcomes is low, the beneficial effect of increased use of labor induction may not outweigh the side effects or the costs.
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Affiliation(s)
- Camilla Haavaldsen
- Department of Obstetrics and GynecologyAkershus University HospitalLørenskogNorway
| | - Nils‐Halvdan Morken
- Department of Obstetrics and GynecologyHaukeland University HospitalBergenNorway,Department of Clinical ScienceUniversity of BergenBergenNorway
| | - Ola Didrik Saugstad
- Department of Pediatric ResearchUniversity of OsloOsloNorway,Ann and Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Anne Eskild
- Department of Obstetrics and GynecologyAkershus University HospitalLørenskogNorway,Institute of Clinical Medicine, University of OsloOsloNorway
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22
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Rosman AN, van Dillen J, Zwart J, Overtoom E, Schaap T, Bloemenkamp K, van den Akker T. Lessons learned from the perinatal audit of uterine rupture in the Netherlands: A mixed‐method study. Health Sci Rep 2022; 5:e664. [PMID: 35949672 PMCID: PMC9353229 DOI: 10.1002/hsr2.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 04/01/2022] [Accepted: 05/15/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Aims To analyze outcomes of nationwide local audits of uterine rupture to draw lessons for clinical care. Methods Descriptive cohort study. Critical incident audit sessions within all local perinatal cooperation groups in the Netherlands. Women who sustained uterine rupture between January 1st, 2017 and December 31st, 2019. Main Outcome Measures Improvable factors, recommendations, and lessons learned for clinical care. Women's case histories were discussed in multidisciplinary perinatal audit sessions. Participants evaluated care against national and local clinical guidelines and common professional standards to identify improvable factors. Cases and outcomes were registered in a nationwide database. Results One hundred and fourteen women who sustained uterine rupture were discussed in local perinatal audit sessions by 40–60 participants on average: A total of 111 (97%) were multiparous of whom 107 (94%) had given birth by cesarean section in a previous pregnancy. The audit revealed 178 improvable factors and 200 recommendations. Six percent (N = 11) of the improvable factors were identified as very likely and 18% (N = 32) as likely to have a relationship with the outcome or occurrence of uterine rupture. Improvable factors were related to inadequate communication, absent, or unclear documentation, delay in diagnosing the rupture, and suboptimal management of labor. Speak up in case a suspicion arises, escalating care by involving specialist obstetricians, addressing the importance of accurate documentation, and improving training related to fetal monitoring were the most frequent recommendations and should be topics for team (skills and drills) training. Conclusions Through a nationwide incident audit of uterine rupture, we identified improvable factors related to communication, documentation, and organization of care. Lessons learned include “speaking up,” improving the transfer of information and team training are crucial to reduce the incidence of uterine rupture.
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Affiliation(s)
- Ageeth N. Rosman
- Perined Utrecht The Netherlands
- Research Center of Innovations in Care Rotterdam University of Applied Sciences, Research Center of Innovations Rotterdam The Netherlands
| | - Jeroen van Dillen
- Department of Obstetrics and Gynecology Radboud University Medical Center Nijmegen The Netherlands
| | - Joost Zwart
- Department of Obstetrics and Gynecology Deventer Hospital Deventer The Netherlands
| | - Evelien Overtoom
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina Children Hospital University Medical Center Utrecht Utrecht The Netherlands
| | - Timme Schaap
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina Children Hospital University Medical Center Utrecht Utrecht The Netherlands
| | - Kitty Bloemenkamp
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina Children Hospital University Medical Center Utrecht Utrecht The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynecology Leiden University Medical Center Leiden The Netherlands
- Athena Institute VU University Amsterdam The Netherlands
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23
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Goodarzi B, Seijmonsbergen‐Schermers A, van Rijn M, Shah N, Franx A, de Jonge A. Maternal characteristics as indications for routine induction of labor: A nationwide retrospective cohort study. Birth 2022; 49:569-581. [PMID: 35229355 PMCID: PMC9546001 DOI: 10.1111/birt.12628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/17/2022] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Maternal characteristics, such as parity and age, are increasingly considered indications for routine induction of labor of otherwise healthy women to prevent fetal and neonatal mortality. To fully balance the risks and benefits of induction of labor, we examined the association of additional relevant maternal characteristics and gestational age with fetal and neonatal mortality. METHODS We conducted a nationwide retrospective cohort study among a healthy Dutch population consisting of all singleton pregnancies in midwife-led care after 37 weeks of gestation in the period 2000-2018. We examined the association of maternal ethnicity, age, parity, and socioeconomic status with fetal and neonatal mortality, stratified by gestational age. The association of single characteristics was examined using descriptive statistics, and univariable and multivariable logistics regression analyses. The associations of multiple characteristics were examined using inter-categorical analyses and using interaction terms in the multivariable logistic regression analyses. RESULTS The results showed that ethnicity, age, parity, socioeconomic status, and gestational age did not act as single determinant of fetal and neonatal mortality. The probability of fetal and neonatal mortality differed among subgroups of women depending on which determinants were considered and the number of determinants included. CONCLUSIONS Decision-making about induction of labor to prevent fetal and neonatal mortality based on a single determinant may lead to overuse or underuse of IOL. A value-based health care strategy, addressing social inequity, and investing in better screening and diagnostic methods that employ an individualized and multi-determinant approach may be more effective at preventing fetal and neonatal mortality.
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Affiliation(s)
- Bahareh Goodarzi
- Department of Midwifery ScienceAmsterdam Public HealthAmsterdam UMCVrije Universiteit AmsterdamAVAGAmsterdamthe Netherlands
| | - Anna Seijmonsbergen‐Schermers
- Department of Midwifery ScienceAmsterdam Public HealthAmsterdam UMCVrije Universiteit AmsterdamAVAGAmsterdamthe Netherlands
| | - Maaike van Rijn
- Department of Obstetrics and GynaecologyHaga ZiekenhuisThe HagueThe Netherlands
| | - Neel Shah
- Department of Obstetrics, Gynaecology and Reproductive BiologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Arie Franx
- Department of Obstetrics and GynaecologyErasmus MCRotterdamthe Netherlands
| | - Ank de Jonge
- Department of Midwifery ScienceAmsterdam Reproduction and DevelopmentAmsterdam UMCVrije Universiteit AmsterdamAVAGAmsterdamthe Netherlands
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24
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Levin G, Tsur A, Burke YZ, Meyer R. Methods of induction of labor after cesarean with no prior vaginal delivery—Perinatal outcomes. Int J Gynaecol Obstet 2022. [DOI: 10.1002/ijgo.14318 10.1002/ijgo.14318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Gabriel Levin
- The Department of Gynecologic Oncology Hadassah Medical Center Jerusalem Israel
- Faculty of Medicine Hebrew University Jerusalem Israel
| | - Abraham Tsur
- Department of Obstetrics and Gynecology Chaim Sheba Medical Center Ramat‐Gan Israel
- Faculty of Medicine Tel‐Aviv‐Hebrew University Tel‐Aviv Israel
| | - Yechiel Z. Burke
- Department of Obstetrics and Gynecology Chaim Sheba Medical Center Ramat‐Gan Israel
- Faculty of Medicine Tel‐Aviv‐Hebrew University Tel‐Aviv Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology Chaim Sheba Medical Center Ramat‐Gan Israel
- Faculty of Medicine Tel‐Aviv‐Hebrew University Tel‐Aviv Israel
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program Sheba Medical Center Ramat‐Gan Israel
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25
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Frank Wolf M, Ben-Nun M, Sgayer I, Shnaider O, Aiob A, Odeh M, Bornstein J. The association between acute lower abdominal pain over a previous caesarean scar and uterine rupture. J OBSTET GYNAECOL 2022; 42:1169-1173. [PMID: 35152819 DOI: 10.1080/01443615.2022.2027896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pregnant women with previous caesarean delivery might suffer from acute lower abdominal pain located at the site of previous caesarean scar (CS). The association between this complaint and uterine rupture (UR) is not fully understood. Therefore, we aimed to examine the risk of UR in women with acute persistent abdominal pain (APAP) over a previous CS and to investigate all the women with UR, with or without APAP and with or without previous CS, in order to determine risk factors, clinical presentation and management. We performed a retrospective analysis on two study groups: women who had APAP over previous CS and women who had UR. We found an incidence of UR in patients with APAP over the previous CS was 0.7%; which doubled the total UR rate among women with previous caesarean in our medical centre (0.35%). Forty percent of the women with APAP over a previous CS had preterm delivery. Twenty percent of the cases of UR occurred in preterm weeks. To conclude, APAP over a previous CS is associated with a doubled risk of UR. Considering this symptom as a preliminary sign of UR might lead to elevated rate of iatrogenic preterm deliveries.Impact statementWhat is already known on this subject? Women with UR may present with abdominal pain which may vary from non-specific mild discomfort to severe acute abdominal pain. Additionally, these women may suffer from acute persistent abdominal pain (APAP) located over the previous caesarean scar. The clinical significance of APAP in these women has not been fully investigated.What do the results of this study add? Lower abdominal pain located at the site of previous CS is associated with a doubled risk of UR. Considering this complaint as a major sign of UR might lead to an elevated rate of iatrogenic preterm deliveries.What are the implications of these findings for clinical practice and/or further research? Further studies are needed to explore whether women with a single complaint of APAP over CS could be managed expectantly and even offered a trial of labour after caesarean delivery (CD).
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Affiliation(s)
- Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maayan Ben-Nun
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Inshirah Sgayer
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Oleg Shnaider
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Alaa Aiob
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Marwan Odeh
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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26
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Kizaki Y, Samejima K, Matsunaga S, Nagai T, Takai Y. An old uterine rupture repaired 2 months postpartum using laparoscopy aided by hysteroscopy: A case report. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2022. [DOI: 10.1016/j.lers.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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27
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Johansen LT, Braut GS, Øian P. Room for improvement in maternity care. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2022; 142:22-0208. [DOI: 10.4045/tidsskr.22.0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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28
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Tesema O, Tilahun T, Kejela G. Determinants of uterine rupture at public hospitals of western Ethiopia: A case–control study. SAGE Open Med 2022; 10:20503121221092643. [PMID: 35492890 PMCID: PMC9047805 DOI: 10.1177/20503121221092643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/17/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction: Uterine rupture is a separation of the entire thickness of the uterine wall with the extrusion of fetal parts to the peritoneal cavity. It contributes to high maternal and perinatal mortality in Ethiopia. This study was aimed to identify determinants of uterine rupture among mothers who gave birth at East Wollega Zone public hospitals. Methods: A facility-based unmatched case–control study was conducted among 239 samples (47 cases and 192 controls) from 5 June 2019 to 30 September 2019. Cases were those with uterine rupture, and controls were those free from uterine rupture. Cases were selected consecutively, and controls were selected using a systematic sampling method. For analysis, data were entered into Epi-data version 3.1 and exported to SPSS version 20. Descriptive statistics were performed to describe the variables. Binary and multivariable logistic regression were used in the analysis. The outputs were presented using an adjusted odds ratio with 95% confidence intervals. Results: Two hundred thirty-nine (47 cases and 192 controls) mothers who gave birth in public hospitals in the East Wollega zone were interviewed, making a response rate of 100%. Living in an urban area (adjusted odds ratio = 0.219, 95% confidence interval: 0.067, 0.717), prolonged labor (adjusted odds ratio = 5.401, 95% confidence interval: 1.825, 15.981), obstructed labor (adjusted odds ratio = 4.333, 95% confidence interval: 1.276, 14.715), previous history of C/S (adjusted odds ratio = 6.5261, 95% confidence interval: 1.889, 22.554), and having no history of female genital cutting (adjusted odds ratio = 0.190, 95% confidence interval: 0.053, 0.682) were predictors of uterine rupture. Conclusion: In this study, socio-demographic, maternal nutrition, obstetric, and health system-related factors were identified as risks of uterine rupture. Particular emphasis should be given to modifiable risk factors to reduce maternal morbidity and mortality in the study area.
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Affiliation(s)
- Oliyad Tesema
- Department of Nursing, Nekemte College of Health Science, Nekemte, Ethiopia
| | - Temesgen Tilahun
- School of Medicine, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Gemechu Kejela
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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29
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Rath W, Hellmeyer L, Tsikouras P, Stelzl P. Mechanical Methods for the Induction of Labour After Previous Caesarean Section – An Updated, Evidence-based Review. Geburtshilfe Frauenheilkd 2022; 82:727-735. [PMID: 35815098 PMCID: PMC9262630 DOI: 10.1055/a-1731-7441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/29/2021] [Indexed: 11/04/2022] Open
Abstract
There are currently no up-to-date evidence-based recommendations on the preferred method to induce labour after previous Caesarean section, especially for patients with unripe cervix, as
randomised controlled studies are lacking. Intravenous oxytocin and misoprostol are contraindicated in these women because of the high risk of uterine rupture. In women with ripe cervix
(Bishop Score > 6), intravenous administration of oxytocin is an effective procedure with comparable rates of uterine rupture to those with spontaneous onset of labour. Vaginal
prostaglandin E
2
(PGE
2
) and mechanical methods (balloon catheters, hygroscopic cervical dilators) are effective methods to induce labour in pregnant women with unripe
cervix and previous Caesarean section. According to current guidelines, the administration of PGE
2
is associated with a higher rate of uterine rupture compared to balloon
catheters. Balloon catheters are therefore a suitable alternative to PGE
2
to induce labour after previous Caesarean section, even though this is an off-label use. In addition to
two meta-analyses published in 2016, 12 mostly retrospective cohort/observational studies with low to moderate levels of evidence have been published on mechanical methods of cervical
ripening after previous Caesarean section. But because of the significant heterogeneity of the studies, substantial differences in study design, and insufficient numbers of pregnant women
included in the studies, it is not possible to make any evidence-based recommendations based on these studies. According to a recent meta-analysis, the average rate using balloon catheters
is approximately 53% and the average rate after spontaneous onset of labour is 72%. The uterine rupture rate was 0.2–0.9% for vaginal PGE
2
and 0.56–0.94% for balloon catheters and
is therefore comparable to the uterine rupture rate associated with spontaneous onset of labour. According to the product informations, hygroscopic cervical dilators (Dilapan-S) are
currently the only method which is not contraindicated for cervical ripening/induction of labour in women with previous Caesarean section, although data are insufficient. Well-designed,
randomised, controlled studies with sufficient case numbers comparing balloon catheters and hygroscopic cervical dilators with mechanical methods and vaginal prostaglandin E
2
/oral
misoprostol are therefore necessary to allow proper decision-making.
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Affiliation(s)
- Werner Rath
- Medizinische Fakultät, Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Lars Hellmeyer
- Klinik für Gynäkologie und Geburtsmedizin, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Patrick Stelzl
- Universitätsklinik für Gynäkologie, Geburtshilfe und Gynäkologische Endokrinologie, Kepler Universitätsklinikum, Johannes Kepler Universität Linz, Linz, Austria
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30
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Dimitrova D, Kästner AL, Kästner AN, Paping A, Henrich W, Braun T. Risk factors and outcomes associated with type of uterine rupture. Arch Gynecol Obstet 2022; 306:1967-1977. [PMID: 35284959 DOI: 10.1007/s00404-022-06452-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To identify risk factors associated with the occurrence of complete uterine rupture (CUR) in comparison to partial uterine rupture (PUR) to further investigate to what extent a standardized definition is needed and what clinical implications can be drawn. METHODS Between 2005 and 2017 cases with CUR and PUR at Charité University Berlin, Germany were retrospectively identified. Demographic, obstetric and outcome variables were analyzed regarding the type of rupture. Binary multivariate regression analysis was conducted to identify risk factors associated with CUR. In addition, the intended route of delivery (trial of labor after cesarean delivery (TOLAC) and elective repeat cesarean delivery (ERCD)), divided according to the type of rupture, was compared. RESULTS 92 cases with uterine rupture were identified out of a total of 64.063 births (0.14%). Puerperal complications were more frequent in CUR (67.9 versus 41.1%, p = 0.021). Multiparity ≥ 3 was more frequent in CUR (31 versus 10.7%, p = 0.020). Factors increasing the risk for CUR were parity ≥ 3 (OR = 3.8, p = 0.025), previous vaginal birth (OR = 4.4, p = 0.011), TOLAC (OR = 6.5, p < 0.001) and the use of oxytocin (OR = 2.9, p = 0.036). After multivariate analysis, the only independent risk factor associated with CUR was TOLAC (OR = 7.4, p = 0.017). CONCLUSION TOLAC is the only independent risk factor for CUR. After optimized antenatal counselling TOLAC and ERCD had comparable short-term maternal and fetal outcomes in a high resource setting. A high number of previous vaginal births does not eliminate the risk of uterine rupture. A clear distinction between CUR and PUR is essential to ensure comparability among studies.
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Affiliation(s)
- D Dimitrova
- Department of Obstetrics and Department of Gynecology With Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- Department of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - A L Kästner
- Department of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A N Kästner
- Department of Surgery, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Paping
- Department of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - W Henrich
- Department of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - T Braun
- Department of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Experimental Obstetrics, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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31
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Meyer R, Levin G. Maternal and perinatal outcome of induction at 39 weeks versus expectant management in labor after cesarean section. Int J Gynaecol Obstet 2022; 159:480-486. [PMID: 35212398 DOI: 10.1002/ijgo.14159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/04/2022] [Accepted: 02/21/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To study induction of labor (IOL) at 39 weeks compared with expectant management among women undergoing labor after cesarean section (LAC) with no prior vaginal delivery. METHODS A retrospective cohort study including all women undergoing LAC with no prior vaginal delivery, between March 2011 and January 2021. We allocated the study cohort into two groups: IOL at 390/7 to 396/7 and all LACs at ≥400/7 weeks of gestation. The primary outcome was a composite of adverse neonatal outcome. The secondary outcome was a composite of adverse maternal outcome. RESULTS Overall, 1022 women met inclusion criteria, of whom 89 (8.7%) had IOL at 390/7 -396/7 weeks and 933 (91.3%) had LAC at ≥400/7 weeks. The composite neonatal outcome rate was comparable between groups (0.186). There were three uterine ruptures (3.4%) in the IOL group and 11 (1.2%) in the LAC at ≥40 weeks group (P = 0.115). The rate of the composite maternal outcomes occurrence was higher in the IOL group (18.0% vs. 10.1%, P = 0.022). CONCLUSION IOL at 39 weeks among women undergoing LAC with no prior vaginal delivery is not associated with improved neonatal outcomes when compared with expectant management but may be associated with a higher rate of adverse maternal outcomes.
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Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel.,The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat-Gan, Israel
| | - Gabriel Levin
- The Department of Gynecologic Oncology, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
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32
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Sugai S, Tsuneki I, Yanase T, Kurabayashi T. Computed tomography in postpartum hemorrhage due to incomplete rupture of an unscarred uterus. Arch Gynecol Obstet 2022; 305:851-853. [PMID: 35179627 PMCID: PMC8967755 DOI: 10.1007/s00404-022-06454-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/11/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Shunya Sugai
- Department of Obstetrics and Gynaecology, Niigata City General Hospital, 463-7, Shumoku, Chuo-ku, Niigata, 950-1197, Japan.
| | - Ikunosuke Tsuneki
- Department of Obstetrics and Gynaecology, Niigata City General Hospital, 463-7, Shumoku, Chuo-ku, Niigata, 950-1197, Japan
| | - Toru Yanase
- Department of Obstetrics and Gynaecology, Niigata City General Hospital, 463-7, Shumoku, Chuo-ku, Niigata, 950-1197, Japan
| | - Takumi Kurabayashi
- Department of Obstetrics and Gynaecology, Niigata City General Hospital, 463-7, Shumoku, Chuo-ku, Niigata, 950-1197, Japan
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33
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Tao J, Mu Y, Chen P, Xie Y, Liang J, Zhu J. Pregnancy complications and risk of uterine rupture among women with singleton pregnancies in China. BMC Pregnancy Childbirth 2022; 22:131. [PMID: 35172764 PMCID: PMC8851699 DOI: 10.1186/s12884-022-04465-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goal of this study was to investigate whether pregnancy complications are associated with an increased risk of uterine rupture (UR) and how that risk changes with gestational age. METHODS We obtained all data from China's National Maternal Near Miss Surveillance System (NMNMSS) between 2012 and 2018. Poisson regression analysis was used to assess the risk of UR with pregnancy complications (preeclampsia, gestational diabetes mellitus, placental abruption, placenta previa and placenta percreta) among 9,454,239 pregnant women. Furthermore, we analysed the risks of UR with pregnancy complications in different gestational age groups. RESULTS The risk of UR was increased 2.0-fold (1.2-fold to 2.7-fold) in women with pregnancy complications (except for preeclampsia). These associations also persisted in women without a previous caesarean delivery. Moreover, an increased risk of UR before term birth was observed among women with gestational diabetes mellitus, placental abruption and placenta percreta. The risk of UR was slightly higher in women with gestational diabetes mellitus who had a large for gestational age (LGA) foetus, especially at 32 to 36 weeks gestation. CONCLUSIONS The risk of UR is associated with gestational diabetes mellitus, placental abruption, placenta previa and placenta percreta, but varies in different gestational ages.
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Affiliation(s)
- Jing Tao
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Mu
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Peiran Chen
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanxia Xie
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Juan Liang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
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34
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Wan S, Yang M, Pei J, Zhao X, Zhou C, Wu Y, Sun Q, Wu G, Hua X. Pregnancy outcomes and associated factors for uterine rupture: an 8 years population-based retrospective study. BMC Pregnancy Childbirth 2022; 22:91. [PMID: 35105342 PMCID: PMC8805328 DOI: 10.1186/s12884-022-04415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Uterine rupture is an obstetrical emergency with serious undesired complications for laboring mothers resulting in fatal maternal and neonatal outcomes. The aim of this study was to assess the incidence of uterine rupture, its association with previous uterine surgery and vaginal birth after caesarean section (VBAC), and the maternal and perinatal implications. Methods This is a population-based retrospective study. All pregnant women treated for ruptured uterus in one center between 2013 and 2020 were included. Their information retrieved from the medical records department were reviewed retrospectively. Results A total of 209,112 deliveries were included and 41 cases of uterine rupture were identified. The incidence of uterine rupture was 1.96/10000 births. Among the 41 cases, 16 (39.0%) had maternal and fetal complications. There were no maternal deaths secondary to uterine rupture, while perinatal fatality related to uterine rupture was 7.3%. Among all cases, 38 (92.7%) were scarred uterus and 3 (7.3%) were unscarred uterus. The most common cause of uterine rupture was previous cesarean section, while cases with a history of laparoscopic myomectomy were more likely to have serious adverse outcomes, such as fetal death. 24 (59.0%) of the ruptures occurred in anterior lower uterine segment. Changes in Fetal heart rate monitoring were the most reliable signs for rupture. Conclusions Incidence of uterine rupture in the study area, Shanghai, China was consistent with developed countries. Further improvements in obstetric care and enhanced collaboration with referring health facilities were needed to ensure maternal and perinatal safety. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04415-6.
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Affiliation(s)
- Sheng Wan
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Mengnan Yang
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Jindan Pei
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Xiaobo Zhao
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Chenchen Zhou
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Yuelin Wu
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Qianqian Sun
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Guizhu Wu
- Department of Gynecology, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China.
| | - Xiaolin Hua
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China.
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Jaiswani AK, Tripathi U, Bansal SJ, Singh V, Jaiswani K. Maternal death due to ruptured uterus consequent to abruptio placentae: 2 case reports. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2021. [DOI: 10.1186/s41935-021-00236-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Abruptio placentae is a complication of pregnancy that can lead to uterine rupture, increasing maternal and fetal mortality, especially when there is a lack of medical outreach in remote areas.
Case presentation
We present two maternal deaths due to uterine rupture in a term pregnancy consequent to abruptio placentae. In one case, the uterus ruptured at the previous lower segment Caesarean section (LSCS) scar site and in another over the lateral wall of Couvelaire uterus. In both cases, the fetus was partially lying outside the uterus in the peritoneal cavity, and there was a massive retro-placental clot.
Conclusions
Early identification of high-risk factors, followed by institutional delivery, may reduce maternal and fetal mortality due to abruption followed by uterine rupture.
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Girmay G, Gultie T, Gebremichael G, Afework B, Temesgen G. Determinants of uterine rupture among mothers who gave birth in Jinka and Arba Minch General Hospitals, institution-based case-control study, Southern Ethiopia, Ethiopia, 2019. ACTA ACUST UNITED AC 2021; 16:1745506520961722. [PMID: 32985385 PMCID: PMC7534070 DOI: 10.1177/1745506520961722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Uterine rupture is a major public health problem in low-income countries including Ethiopia. In Ethiopia, its prevalence is low, but it results in devastative health problems of the mother and her baby. Even though the Ethiopian government and nongovernmental organizations tried to strengthen the health care system, significant adverse maternal and fetal outcome is still associated with uterine rupture. The aim of this study was to identify determinants of uterine rupture in Jinka and Arba Minch General Hospitals. Methods: The study was conducted in Jinka and Arba Minch General Hospitals, and the data collection period was 15 to 30 November 2018. A case–control study design was used with simple random sampling of 1:4. Data were collected using data extraction sheets. Variables with p < 0.25 in bivariate logistic regression were entered into multivariable logistic regression. Variables with p < 0.05 in multivariable logistic regression were used to determine significant association between dependent and independent variables. Result: Uterine rupture occurred in 112 cases with 448 controls. Women referred from health facilities (adjusted odds ratio = 8.0, 95% confidence interval: 3.5–17.8), multiparous women (adjusted odds ratio = 12.7, 95% confidence interval: 4.2–39.0), duration of labor more than 18 h (adjusted odds ratio = 11.5, 95% confidence interval: 5.5–24.1), malpresentation (adjusted odds ratio = 3.5, 95% confidence interval: 1.0–8.0) and gestational age of ⩾37 weeks (adjusted odds ratio = 5.2, 95% confidence interval: 1.4–19.3) were independent factors associated with uterine rupture. Conclusion: Mothers referred from health facilities, multiparous women, duration of labor more than 18 h, gestational age of ⩾37 weeks and malpresentation were significantly associated with uterine rupture. Early referral, encouraging family planning, proper use of partograph, early identification and appropriate intervention for malpresentation are recommended.
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Affiliation(s)
- Goitom Girmay
- Department of Midwifery, Aksum University, Axum, Ethiopia
| | | | | | - Bezawit Afework
- Department of Midwifery, Arba Minch University, Arba Minch, Ethiopia
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Al Naimi A, Jennewein L, Mouzakiti N, Louwen F, Bahlmann F. The effect of the onset of labor on the characteristics of the cesarean scar. Int J Gynaecol Obstet 2021; 157:322-326. [PMID: 34077556 DOI: 10.1002/ijgo.13775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/19/2021] [Accepted: 06/01/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the effect of cesarean section (CS) timing, elective versus unplanned, on the residual myometrial thickness (RMT) and CS scars. METHODS This is a prospective single-blinded observational cohort study with 186 observations. Patients indicated to undergo first singleton CS were preoperatively recruited. Exclusion criteria were history of repeated CS, vertical hysterotomy, diabetes, and additional uterine surgeries. Sonographic examination was performed for assessing the RMT ratio, the presence of a niche, fibrosis, and the distance from the scar to the internal os (SO) 1 year after CS. Power analysis was performed with 0.05 α, 0.1 β, and all statistical analyses were conducted with Stata® . RESULTS Wilcoxon rank-sum test for the association between CS timing, RMT ratio and SO showed Z values of -0.59 and -4.94 (P = 0.553 and P < 0.001), respectively. There was no association between CS timing and niches and fibrosis (P > 0.99 and P = 0.268, respectively). Linear regression between SO and the extent of cervical dilatation showed a -0.45 β (95% confidence interval -0.68 to -0.21) and a 10.22-mm intercept (P < 0.001). CONCLUSION RMT is independent of the timing of CS, but the SO distance shows a negative linear relationship with the cervical dilatation.
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Affiliation(s)
- Ammar Al Naimi
- Department of Obstetrics and Gynecology, Goethe University Frankfurt am Main, University Hospital, Frankfurt, Hessen, Germany.,Department of Obstetrics and Gynecology, Buergerhospital-Dr. Senckenbergische Stiftung, Frankfurt, Hessen, Germany
| | - Lukas Jennewein
- Department of Obstetrics and Gynecology, Goethe University Frankfurt am Main, University Hospital, Frankfurt, Hessen, Germany
| | - Niki Mouzakiti
- Department of Obstetrics and Gynecology, Buergerhospital-Dr. Senckenbergische Stiftung, Frankfurt, Hessen, Germany
| | - Frank Louwen
- Department of Obstetrics and Gynecology, Goethe University Frankfurt am Main, University Hospital, Frankfurt, Hessen, Germany
| | - Franz Bahlmann
- Department of Obstetrics and Gynecology, Buergerhospital-Dr. Senckenbergische Stiftung, Frankfurt, Hessen, Germany
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Harrison MS, Garces A, Figueroa L, Westcott J, Hambidge M, Krebs NF. How birth outcomes among a cohort of Guatemalan women with a history of prior cesarean vary by mode or birth across different interpregnancy intervals. Reprod Health 2021; 18:99. [PMID: 34020660 PMCID: PMC8147511 DOI: 10.1186/s12978-021-01153-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Our objectives were to analyze how pregnancy outcomes varied by cesarean birth as compared to vaginal birth across varying interpregnancy intervals (IPI) and determine if IPI modified mode of birth. METHODS This secondary analysis used data from a prospective registry of home and hospital births in Chimaltenango, Guatemala from January 2017 through April 2020, through the Global Network for Women's and Children's Health Research. Bivariate comparisons and multivariable logistic regression were used to answer our study question, and the data was analyzed with STATA software v.15.1. RESULTS Of 26,465 Guatemalan women enrolled in the registry, 2794 (10.6%) had a history of prior cesarean. 560 (20.1%) women delivered by vaginal birth after cesarean with the remaining 2,233 (79.9%) delivered by repeat cesarean. Repeat cesarean reduced the risk of needing a dilation and curettage compared to vaginal birth after cesarean, but this association did not vary by IPI, all p-values > p = 0.05. Repeat cesarean delivery, as compared to vaginal birth after cesarean, significantly reduced the likelihood a woman breastfeeding within one hour of birth (AOR ranged from 0.009 to 0.10), but IPI was not associated with the outcome. Regarding stillbirth, repeat cesarean birth reduced the likelihood of stillbirth as compared to vaginal birth (AOR 0.2), but again IPI was not associated with the outcome. CONCLUSION Outcomes by mode of delivery among a Guatemalan cohort of women with a history of prior cesarean birth do not vary by IPI.
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Affiliation(s)
- Margo S Harrison
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- University of Colorado Anschutz Medical Campus, Mail Stop B198-2, Academic Office 1, 12631 E. 17th Avenue, Rm 4211, Aurora, CO, 80045, USA.
| | - Ana Garces
- Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Lester Figueroa
- Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Jamie Westcott
- Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | | | - Nancy F Krebs
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Zhou Y, Mu Y, Chen P, Xie Y, Zhu J, Liang J. The incidence, risk factors and maternal and foetal outcomes of uterine rupture during different birth policy periods: an observational study in China. BMC Pregnancy Childbirth 2021; 21:360. [PMID: 33952183 PMCID: PMC8098017 DOI: 10.1186/s12884-021-03811-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/26/2021] [Indexed: 01/15/2023] Open
Abstract
Background Currently, there are no studies on changes in the incidence of uterine rupture or maternal and foetal outcomes in women with uterine rupture during different birth policy periods in China. Moreover, the results of association studies of maternal age, parity and previous caesarean section number with the risk of maternal and foetal outcomes in women with uterine rupture have not been consistent. This research aims to conduct and discuss the above two aspects. Methods We included singleton pregnant women with no maternal complications other than uterine rupture from January 2012 to June 2019 in China’s National Maternal Near Miss Surveillance System. The data in this study did not differentiate between complete and partial uterine rupture and uterine dehiscence. Through Poisson regression analysis with a robust variance estimator, we compared the incidences of uterine rupture and maternal and foetal outcomes in women with uterine rupture during different birth policy periods in China and determined the relationship between maternal age, parity or previous caesarean section number and uterine rupture or maternal and foetal outcomes in women with uterine rupture. Results This study included 8,637,723 pregnant women. The total incidences of uterine rupture were 0.13% (12,934) overall, 0.05% during the one-child policy, 0.12% during the partial two-child policy (aRR = 1.96; 95% CI: 1.53–2.52) and 0.22% (aRR = 2.89; 95% CI: 1.94 4.29) during the universal two-child policy. The maternal near miss and stillbirth rates in women with uterine rupture were respectively 2.35% (aRR = 17.90; 95% CI: 11.81–27.13) and 2.12% (aRR = 4.10; 95% CI: 3.19 5.26) overall, 5.46 and 8.18% during the first policy, 1.72% (aRR = 0.60; 95% CI: 0.32–1.17) and 2.02% (aRR = 0.57; 95% CI: 0.37–0.83) during the second policy, and 1.99% (aRR = 0.90; 95% CI: 0.52–1.53) and 1.04% (aRR = 0.36; 95% CI: 0.24–0.54) during the third policy. The risk of uterine rupture increased with parity and previous caesarean section number. Conclusion The uterine rupture rate in China continues to increase among different birth policy periods, and the risk of maternal near miss among women with uterine rupture has not significantly improved. The Chinese government, obstetricians, and scholars should work together to reverse the rising rate of uterine rupture and improve the pregnancy outcomes in women with uterine rupture. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03811-8.
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Affiliation(s)
- Yangwen Zhou
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Chengdu City, Sichuan Province, 610041, P. R. China
| | - Yi Mu
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Peiran Chen
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Chengdu City, Sichuan Province, 610041, P. R. China
| | - Yanxia Xie
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Chengdu City, Sichuan Province, 610041, P. R. China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Chengdu City, Sichuan Province, 610041, P. R. China. .,Key Laboratory of Birth Defects And Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Juan Liang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Chengdu City, Sichuan Province, 610041, P. R. China. .,National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Chengdu City, Sichuan Province, 610041, P. R. China.
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Chudal D, Shrestha S, Shrestha R, Paudel V. Rupture Uterus in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2021; 59:392-395. [PMID: 34508533 PMCID: PMC8369591 DOI: 10.31729/jnma.5894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/07/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Rupture uterus is an obstetric catastrophe with poor maternal and fetal outcome. The objective of the study is to determine the prevalence of rupture uterus in pregnancy. METHODS This was a descriptive cross sectional study conducted in a tertiary care centre from January 2016 to December 2016 after taking ethical approval (Approval No. F-NMC-510/76/77) from Institutional Review Committee. Convenience sampling method was used. Data were entered in the Microsoft Excel sheet and obtained data was analysed using Statistical Package for Social Sciences version 18 software for central tendency and frequencies. RESULTS Out of total 1559 deliveries, prevalence of rupture uterus was found to be 12 (0.0077%). Previous lower segment caesarean scar rupture was the most common risk factor noted in 7 (58.3%) cases. A total of seven patients (58.3%) required intensive care unit admission and blood transfusion. Other maternal complications were surgical site infection 2 (16.67%), sepsis 2 (16.67%), paralytic ileus 1 (8.3%), pelvic collection 1 (8.3%) and vesico vaginal fistula 1 (8.3%). Two maternal deaths (16.67%) and perinatal death was noted in 8 (66.66 % ) cases. CONCLUSIONS Rupture uterus most commonly occurred in scarred uterus. Identification of high risk pregnancy, judicious caesarean section, proper labor monitoring, early diagnosis and prompt management are essential in reducing its occurrences.
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Assessing lateral uterine wall defects and residual myometrial thickness after cesarean section. Eur J Obstet Gynecol Reprod Biol 2021; 258:391-395. [PMID: 33540191 DOI: 10.1016/j.ejogrb.2021.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Lateral wall ruptures in women with a history of cesarean section are less common but more complicated than anterior wall ruptures. Residual myometrial thickness (RMT) is believed to be valuable for assessing the probability of ruptures. This study aimed to assess the utility of OmniView (a sonographic reslicing technique) in evaluating the lateral uterine wall after cesarean section and evaluate the relationship between lateral and anterior wall RMT using OmniView and sagittal two-dimensional ultrasound. STUDY DESIGN This cross-sectional study examined changes in both the anterior and lateral uterine wall in women with a history of cesarean section in the past 12-18 months. OmniView with volume contrast imaging with a 2-mm slice thickness was used to generate coronal planes, and the OmniView RMT (OV-RMT) was calculated as a percentage. Blinded to the OV-RMT results, sonographic multiplanar views were used to acquire the optimum sagittal plane for evaluating the RMT, and the sagittal RMT (S-RMT) was calculated as a percentage. The reproducibility of OV-RMT and S-RMT between two observers was tested using interclass correlation (ICC). The relationship between two variables was tested using Spearman's rank correlation. RESULTS In 208 recruited patients, the prevalence of lateral uterine wall defects was 79 %. The interobserver and intraobserver reproducibility of S-RMT and OV-RMT had ICC coefficients over 0.9 with a p-value <0.001. S-RMT and OV-RMT did not follow a normal distribution, and the medians were significantly different (55.5 and 85.7, respectively). Spearman's rank correlation between OV-RMT and S-RMT had a rho (ρ) value of 0.24 (p < 0.05). Passing-Bablok regression had an intercept of 47.95 and a slope of 0.65. CONCLUSION OmniView can be used to assess lateral uterine wall defects, and OV-RMT is a reproducible and reliable method for quantifying this assessment. The RMT on the coronal plane was independently more intact than that on the sagittal plane, which might account for the lower incidence of lateral ruptures. Further studies could reveal a critical OV-RMT value that is safe for a trial of labor.
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Ram M, Hiersch L, Ashwal E, Yogev Y, Aviram A. Trial of labor after previous single cesarean delivery in grand-multiparous women: a retrospective cohort study. Arch Gynecol Obstet 2021; 304:329-336. [PMID: 33389110 DOI: 10.1007/s00404-020-05946-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare pregnancy outcomes in grand-multiparous (GMP) women with and without one previous cesarean delivery (CD), and to evaluate the number of previous successful vaginal deliveries after a CD needed to reduce the complication rate of trials of labor after a previous CD. METHODS This is a retrospective cohort study of women with singleton pregnancy at term who had a trial of vaginal delivery between 2007 and 2014 at a tertiary medical center. We compared pregnancy outcomes in GMP women with and without one previous cesarean delivery. The primary outcome was mode of delivery and secondary outcomes were uterine rupture and composite maternal and neonatal morbidity. For the secondary objective, we compared pregnancy outcomes in women in TOLAC, stratified by the number of previous vaginal deliveries. RESULTS Overall, 2815 GMP women met the study criteria, of which 310 (11%) had a previous cesarean delivery. The rate of a successful vaginal deliveries (VBAC) was similar, regardless of the presence of a previous cesarean delivery. No other differences in outcomes were found between the groups. In a secondary analysis, it was found that the presence of a single previous VBAC (compared to no previous VBACs) increased the odds of achieving a vaginal delivery in the next trial of labor after cesarean delivery (TOLAC) (aOR 5.66; 95% CI 3.73-8.60), and decreased the risk of maternal or neonatal adverse outcomes (aOR 0.62; 95% CI 0.39-0.97, and aOR 0.49; 95% CI 0.25-0.97, respectively). Multiple prior VBACs (as compared to a single prior VBAC) did not increase the odds of achieving another VBAC. CONCLUSION Grand-multiparous women with and without previous uterine scar have comparable pregnancy outcomes. Additionally, after the first VBAC, additional successful VBACs do not improve the success rate in the next TOLAC.
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Affiliation(s)
- Maya Ram
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Hiersch
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Ashwal
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Aviram
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
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Abstract
ABSTRACT Third-trimester bleeding is an obstetric emergency and is associated with significant maternal and fetal morbidity and mortality. The two most common causes for third-trimester bleeding are placental abruption and placenta previa, which account for about half of all cases. Clinicians should have a thorough understanding of the risk factors, clinical presentation, and appropriate management of these conditions. Timely management is necessary for the survival of mother and fetus and to reduce the incidence of neonatal complications.
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Affiliation(s)
- Jill W Cunningham
- Jill W. Cunningham is an associate professor and didactic director of the PA program at the Philadelphia College of Osteopathic Medicine. The author has disclosed no potential conflicts of interest, financial or otherwise
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Scher MS. "The First Thousand Days" Define a Fetal/Neonatal Neurology Program. Front Pediatr 2021; 9:683138. [PMID: 34408995 PMCID: PMC8365757 DOI: 10.3389/fped.2021.683138] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/27/2021] [Indexed: 01/11/2023] Open
Abstract
Gene-environment interactions begin at conception to influence maternal/placental/fetal triads, neonates, and children with short- and long-term effects on brain development. Life-long developmental neuroplasticity more likely results during critical/sensitive periods of brain maturation over these first 1,000 days. A fetal/neonatal program (FNNP) applying this perspective better identifies trimester-specific mechanisms affecting the maternal/placental/fetal (MPF) triad, expressed as brain malformations and destructive lesions. Maladaptive MPF triad interactions impair progenitor neuronal/glial populations within transient embryonic/fetal brain structures by processes such as maternal immune activation. Destructive fetal brain lesions later in pregnancy result from ischemic placental syndromes associated with the great obstetrical syndromes. Trimester-specific MPF triad diseases may negatively impact labor and delivery outcomes. Neonatal neurocritical care addresses the symptomatic minority who express the great neonatal neurological syndromes: encephalopathy, seizures, stroke, and encephalopathy of prematurity. The asymptomatic majority present with neurologic disorders before 2 years of age without prior detection. The developmental principle of ontogenetic adaptation helps guide the diagnostic process during the first 1,000 days to identify more phenotypes using systems-biology analyses. This strategy will foster innovative interdisciplinary diagnostic/therapeutic pathways, educational curricula, and research agenda among multiple FNNP. Effective early-life diagnostic/therapeutic programs will help reduce neurologic disease burden across the lifespan and successive generations.
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Affiliation(s)
- Mark S Scher
- Division of Pediatric Neurology, Department of Pediatrics, Fetal/Neonatal Neurology Program, Emeritus Scholar Tenured Full Professor in Pediatrics and Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
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Desta M, Amha H, Anteneh Bishaw K, Adane F, Assemie MA, Kibret GD, Yimer NB. Prevalence and predictors of uterine rupture among Ethiopian women: A systematic review and meta-analysis. PLoS One 2020; 15:e0240675. [PMID: 33137135 PMCID: PMC7605683 DOI: 10.1371/journal.pone.0240675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/30/2020] [Indexed: 11/24/2022] Open
Abstract
Background Uterine rupture has a significant public health importance, contributing to 13% of maternal mortality and 74%-92% of perinatal mortality in Sub-Saharan Africa, and 36% of maternal mortality in Ethiopia. The prevalence and predictors of uterine rupture were highly variable and inconclusive across studies in the country. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence and predictor of uterine rupture in Ethiopia. Methods This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 checklist. PubMed, Cochrane Library, Google Scholar, and African Journals Online databases were searched. The Newcastle- Ottawa quality assessment tool was used for critical appraisal. I2 statistic and Egger’s tests were used to assess the heterogeneity and publication bias, respectively. The random-effects model was used to estimate the pooled prevalence and odds ratios with a 95% confidence interval. Results Sixteen studies were included, with a total of 91,784 women in the meta-analysis. The pooled prevalence of uterine rupture was 2% (95% CI: 1.99, 3.01). The highest prevalence was observed in the Amhara regional state (5%) and the lowest was in Tigray region (1%). Previous cesarean delivery (OR = 9.95, 95% CI: 3.09, 32.0), lack of antenatal care visit (OR = 8.40, 95% CI: 4.5, 15.7), rural residence (OR = 4.75, 95% CI: 1.17, 19.3), grand multiparity (OR = 4.49, 95% CI: 2.83, 7.11) and obstructed labor (OR = 6.75, 95%CI: 1.92, 23.8) were predictors of uterine rupture. Conclusion Uterine rupture is still high in Ethiopia. Therefore, proper auditing on the appropriateness of cesarean section and proper labor monitoring, improving antenatal care visit, and birth preparedness and complication readiness plan are needed. Moreover, early referral and family planning utilization are the recommended interventions to reduce the burden of uterine rupture among Ethiopia women.
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Affiliation(s)
- Melaku Desta
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- * E-mail:
| | - Haile Amha
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Keralem Anteneh Bishaw
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Fentahun Adane
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Moges Agazhe Assemie
- Department of Public health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Getiye Dejenu Kibret
- Department of Public health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Nigus Bililign Yimer
- Department of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia
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Powell JM, Hersh AR, Greiner KS, Frank ZC, Pilliod RA, Caughey AB. Obstetric management for stillbirth complicated by a prior cesarean delivery: a cost-effectiveness analysis. J Matern Fetal Neonatal Med 2020; 35:3684-3693. [PMID: 33103519 DOI: 10.1080/14767058.2020.1837770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The primary concern for a trial of labor after cesarean (TOLAC) is a uterine rupture leading to neonatal injury or mortality and maternal mortality. In individuals who have a term stillbirth, the neonatal concern is absent, yet repeat cesarean delivery remains common in this setting. Given the increased maternal risks from cesarean, it is important to evaluate obstetric management options in the population of women who have a term stillbirth and prior cesarean delivery (CD). OBJECTIVES To examine the outcomes and costs of a TOLAC via induction of labor verses a repeat CD for cases of stillbirth occurring near term. STUDY DESIGN A decision-analytic model incorporating the current and a subsequent delivery using TreeAge software was designed to compare outcomes in women induced for a TOLAC to those undergoing repeat CD in the setting of stillbirth at 34-41 weeks' gestation. We used a theoretical cohort of 6000 women, the estimated annual number of women a prior cesarean who experience a stillbirth in the United States. Outcomes included quality-adjusted life years (QALY) for both modes of delivery with consideration of future pregnancy risks. Future pregnancy risks included uterine rupture, hysterectomy, placenta accreta, maternal death, neonatal death, and neonatal neurological deficits. Probabilities were derived from the literature, and a cost-effectiveness threshold was set at $100,000/QALY. RESULTS In our theoretical cohort of 6000 women with a prior CD and current stillbirth, induction of labor resulted in 4836 fewer cesarean deliveries during stillbirth management, 1040 fewer cesarean deliveries in the subsequent pregnancy, and 14 fewer cases of placenta accreta in the subsequent pregnancy, despite 29 additional uterine ruptures across both pregnancies. Induction of labor was found to be the dominant strategy, resulting in decreased costs and increased QALYs. Univariate sensitivity analyses demonstrated that induction of labor was cost effective until the risk of uterine rupture in the first delivery exceeded 0.83% (baseline estimate: 0.38%). Additional univariate sensitivity analyses found that induction of labor was cost effective until the risk of IOL failure in the first delivery exceeded 64% (baseline estimate: 19%). CONCLUSION In our theoretical cohort, induction of labor for TOLAC in the setting of a stillbirth with a history of prior CD is cost effective compared to a repeat CD. The results of this analysis demonstrate the benefit of induction of labor among women in this scenario who desire a future pregnancy.
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Affiliation(s)
- Jacqueline M Powell
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Alyssa R Hersh
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Karen S Greiner
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Zoe C Frank
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Rachel A Pilliod
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Aaron B Caughey
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
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Alemu AA, Bitew MS, Gelaw KA, Zeleke LB, Kassa GM. Prevalence and determinants of uterine rupture in Ethiopia: a systematic review and meta-analysis. Sci Rep 2020; 10:17603. [PMID: 33077758 PMCID: PMC7572500 DOI: 10.1038/s41598-020-74477-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 09/21/2020] [Indexed: 12/02/2022] Open
Abstract
Uterine rupture is a serious public health concern that causes high maternal and perinatal morbidity and mortality in the developing world. Few of the studies conducted in Ethiopia show a high discrepancy in the prevalence of uterine rupture, which ranges between 1.6 and 16.7%. There also lacks a national study on this issue in Ethiopia. This systematic and meta-analysis, therefore, was conducted to assess the prevalence and determinants of uterine rupture in Ethiopia. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic review and meta-analysis of studies. All observational published studies were retrieved using relevant search terms in Google scholar, African Journals Online, CINHAL, HINARI, Science Direct, Cochrane Library, EMBASE and PubMed (Medline) databases. Newcastle–Ottawa assessment checklist for observational studies was used for critical appraisal of the included articles. The meta-analysis was done with STATA version 14 software. The I2 test statistics were used to assess heterogeneity among included studies, and publication bias was assessed using Begg's and Egger's tests. Odds ratio (OR) with a 95% confidence interval (CI) was presented using forest plots. A total of twelve studies were included in this study. The pooled prevalence of uterine rupture was 3.98% (95% CI 3.02, 4.95). The highest (7.82%) and lowest (1.53%) prevalence were identified in Amhara and Southern Nations, Nationality and Peoples Region (SNNPR), respectively. Determinants of uterine rupture were urban residence (OR = 0.15 (95% CI 0.09, 0.23)), primipara (OR = 0.12 (95% CI 0.06, 0.27)), previous cesarean section (OR = 3.23 (95% CI 2.12, 4.92)), obstructed labor(OR = 12.21 (95% CI 6.01, 24.82)), and partograph utilization (OR = 0.12 (95% CI 0.09, 0.17)). Almost one in twenty-five mothers had uterine rupture in Ethiopia. Urban residence, primiparity, previous cesarean section, obstructed labor and partograph utilization were significantly associated with uterine rupture. Therefore, intervention programs should address the identified factors to reduce the prevalence of uterine rupture.
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Affiliation(s)
- Addisu Alehegn Alemu
- College of Health Sciences, Debre Markos University, P.O.Box: 269, Debre Markos, Ethiopia.
| | | | - Kelemu Abebe Gelaw
- College of Health Sciences, Wolita Sodo University, Wolita Sodo, Ethiopia
| | - Liknaw Bewket Zeleke
- College of Health Sciences, Debre Markos University, P.O.Box: 269, Debre Markos, Ethiopia
| | - Getachew Mullu Kassa
- College of Health Sciences, Debre Markos University, P.O.Box: 269, Debre Markos, Ethiopia
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Yim S, Yeo I, Lee M, Kyeong KS, Cho HY, Kang JB, Kyung MS. Case Report: Spontaneous perforation of a bicornuate uterus with concomitant sarcoma. F1000Res 2020; 9:1143. [PMID: 33447379 PMCID: PMC7783531 DOI: 10.12688/f1000research.25961.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/25/2022] Open
Abstract
A 47-year-old nulliparous, virginal woman presented to the emergency department with acute abdominal pain. Emergency pelvic ultrasound and abdominal CT were taken, which showed a significant amount of hemoperitoneum and a bicornuate uterus with about 18cm x 10cm mass on left uterus. Since the mass had increased vascularity and irregular margins, we thought that the mass could be a uterine sarcoma. MRI and PET/CT were taken additionally for oncologic evaluation before surgery. Intra operative findings showed a ruptured bicornuate uterus with a large mass within the left uterine horn. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Pathologic analysis confirmed an undifferentiated uterine sarcoma. She was treated with 6 cycles of chemotherapy(etoposide, ifosfamide, cisplatin) postoperatively. Chest and abdomen CT for follow up after chemotherapy showed no sign of cancer recurrence. We suggest a bicornuate uterus with concomitant sarcoma should be concerned as a possible cause of uterine rupture by reviewing this case.
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Affiliation(s)
- Soobin Yim
- Department of Obstetrics & Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Inji Yeo
- Department of Obstetrics & Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Myunghwa Lee
- Department of Obstetrics & Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Kyu-Sang Kyeong
- Department of Obstetrics & Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Hye-Yon Cho
- Department of Obstetrics & Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Jung Bae Kang
- Department of Obstetrics & Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Min Sun Kyung
- Department of Obstetrics & Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
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Park BY, Cryer A, Betoni J, McLean L, Figueroa H, Contag SA, Yao R. Outcomes of labor induction at 39 weeks in pregnancies with a prior cesarean delivery. J Matern Fetal Neonatal Med 2020; 35:2853-2858. [PMID: 32847441 DOI: 10.1080/14767058.2020.1807505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The optimal timing of induction for those undergoing a trial of labor after cesarean section has not been established. The little data which supports the consideration of induction at 39 weeks gestation excludes those with a history of prior cesarean section. OBJECTIVE To determine the risks and benefits of elective induction of labor (IOL) at 39 weeks compared with expectant management (EM) until 42 weeks in pregnancies complicated by one previous cesarean delivery. STUDY DESIGN This is a retrospective cohort analysis of singleton non-anomalous pregnancies in the United States between January 2015 and December 2017. Data was provided by the CDC National Center for Health Statistics, Division of Vital Statistics. Analyses included only pregnancies with a history of one previous cesarean delivery (CD). Perinatal outcomes of pregnancies electively induced at 39 weeks (IOL) were compared to pregnancies that were induced, augmented or underwent spontaneous labor between 40 and 42 weeks (EM). Unlabored cesarean deliveries were excluded. Outcomes of interest included: cesarean delivery, intra-amniotic infection, blood transfusion, adult intensive care unit (ICU) admission, uterine rupture, hysterectomy, 5-minute Apgar score ≤3, prolonged neonatal ventilation, neonatal ICU (NICU) admission, neonatal seizure, perinatal/neonatal death. Log-binomial regression analysis was performed to calculate the relative risk (RR) for each outcome of interest, adjusting for confounding variables. RESULTS There were 50,136 pregnancies included for analysis with 9,381 women in the IOL group. Compared with EM, IOL at 39 weeks decreased the risk of intra-amniotic infection (1.7% vs 3.0%, p < .001; aRR: 0.58, 95% CI: [0.49-0.68]), blood transfusion (0.3% vs. 0.5%, p = .03; aRR: 0.66, 95% CI: [0.45-0.98]), and low 5-minute Apgar score (0.31% vs 0.47%, p = .031; aRR: 0.66, 95% CI: [0.44-0.97]). Conversely, IOL increased the risk of cesarean delivery (49.0% vs 27.6%, p < .001; aRR: 1.72, 95% CI: [1.68-1.77]). Furthermore, in the EM group, 919 pregnancies developed preeclampsia and 42 progressed to eclampsia. There were no differences in other perinatal outcomes. CONCLUSION In pregnancies complicated by one previous cesarean delivery, elective induction of labor at 39 weeks reduced the risk of intra-amniotic infection, blood transfusion, and low 5-minute Apgar score while increased the risk of repeat cesarean delivery.
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Affiliation(s)
- Bo Y Park
- Department of Public Health, California State University, Fullerton, CA, USA
| | - Alica Cryer
- Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, CA, USA
| | - James Betoni
- Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, CA, USA
| | - Lynn McLean
- Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, CA, USA
| | - Heather Figueroa
- Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, CA, USA
| | - Stephen A Contag
- Department of Obstetrics and Gynecology, University of Minnesota School of Medicine, MN, USA
| | - Ruofan Yao
- Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, CA, USA
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50
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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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