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Zhang L, Chen L, Hong X, Zheng D, Ying H, Hong L. Complete rupture of the pregnant uterus: A 12-year retrospective study. Int J Gynaecol Obstet 2024. [PMID: 38702923 DOI: 10.1002/ijgo.15576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/18/2024] [Accepted: 04/20/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To assess the frequency of uterine ruptures, clinical characteristics, and maternal and neonatal outcomes in a tertiary referral center. METHODS Information on complete uterine rupture between July 2010 and June 2022 was investigated retrospectively at a tertiary center. RESULTS There were 42 cases of complete uterine rupture in 144 474 deliveries, with an incidence rate of 0.029%. Twenty-seven cases had a scarred uterus and 15 had an unscarred uterus; Rupture of the lower uterine segment was predominant in the scarred uterus, whereas rupture of the body of the uterus was predominant in the non-scarred uterus (P ≤ 0.001). Newborns with Apgar score of 7 or less at 1 min in the non-scarred uterus group was more than that in the scarred uterus group (P = 0.001). There were no significant differences in the history of gynecologic surgery, induction of labor, mode of delivery, clinical features, maternal outcomes, neonatal weight, preterm birth rate, 5-min Apgar score, or neonatal mortality between the two groups (P > 0.05). CONCLUSION The clinical manifestations of uterine rupture are mainly abdominal pain, abnormal fetal heartbeat, or vaginal bleeding. Attention should also be paid to the history of previous uterine surgery. Strict prenatal management, early identification, and aggressive management can help improve maternal and child outcomes. Hysterectomy is not imperative.
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Affiliation(s)
- Li Zhang
- Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, Ningbo, China
| | - Liang Chen
- Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, Ningbo, China
| | - Xunyu Hong
- Intensive Care Department, Ningbo Women and Children's Hospital, Ningbo, China
| | - Dan Zheng
- Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, Ningbo, China
| | - Hongjun Ying
- Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, Ningbo, China
| | - Ling Hong
- Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, Ningbo, China
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Phillips L, Brown H, Williams A. Uterine rupture of an unscarred gravid uterus at term attributed to adenomyosis. BMJ Case Rep 2023; 16:e257145. [PMID: 38086577 PMCID: PMC10728938 DOI: 10.1136/bcr-2023-257145] [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: 12/18/2023] Open
Abstract
Uterine rupture is a rare obstetric emergency that is typically associated with the presence of scar tissue such as in the case of previous caesarean section. In this case report, a primigravid patient presented to the hospital in cardiac arrest with massive haemoperitoneum secondary to a posterior uterine rupture. The histological specimen was found to have diffuse adenomyosis at the site of rupture. On review of the literature, there is insufficient evidence to suggest we as clinicians should alter the antenatal care for patients with known adenomyosis; however, this case highlights how we should have a high index of suspicion for those presenting with signs and symptoms of uterine rupture with known adenomyosis in the absence of other risk factors.
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Affiliation(s)
- Lucy Phillips
- Obstetrics and Gynaecology, Royal Sussex County Hospital, Brighton, UK
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Sgayer I, Dabbah S, Farah RK, Wolf M, Ashkar N, Lowenstein L, Odeh M. Spontaneous Rupture of the Unscarred Uterus: A Review of the Literature. Obstet Gynecol Surv 2023; 78:759-765. [PMID: 38134341 DOI: 10.1097/ogx.0000000000001205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Importance Uterine rupture is defined as a nonsurgical disruption of all layers of the uterus. Most ruptures occur in the presence of a scar, usually secondary to a previous cesarean delivery. Rupture of an unscarred uterus is rare and is associated with severe maternal and neonatal outcomes. Objective To outline the literature on potential predisposing factors, clinical findings, and maternal and fetal outcomes of a rupture of an unscarred uterus. Evidence Acquisition PubMed was searched for the phrases "uterine rupture," "unscarred," and "spontaneous." Individual case reports, retrospective case series, and review articles in English between 1983 and 2020 were included. Results We found 84 case reports in 79 articles. The mean maternal age was 29.3 (SD, 5.7) years; 38 women (45.2%) were nulliparous. Uterine rupture occurred in 37% of the women at term; in 9.9%, the gestational age was ≤12 weeks. The most common clinical presentations were abdominal pain (77.4%), signs of hypovolemic shock (36.9%), fetal distress (31%), and vaginal bleeding (22.6%). The most common risk factors were the use of uterotonic drugs for induction or augmentation of labor and a prior curettage procedure. The most frequently ruptured site was the body of the uterus. Hysterectomy managed 36.9% of the ruptures. Four women died (4.8%). Perinatal mortality was 50.6%. Perinatal death was higher in developing than developed countries. Conclusions and relevance Although rare, spontaneous rupture of the unscarred uterus has serious consequences to the mother and the fetus and should be included in the differential diagnosis of acute abdomen in pregnancy.
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Affiliation(s)
- Inshirah Sgayer
- Head of Maternal and Fetal Clinic, Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya; Clinical Lecturer, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Shirin Dabbah
- Medical Student, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Rola Khamisy Farah
- Clalit Health Service, Akko, Senior Lecturer, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Maya Wolf
- Head of Maternal and Fetal Medicine Unit, Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya; Senior Lecturer, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Nadine Ashkar
- Resident of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Galilee Medical Center
| | - Lior Lowenstein
- Head of Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya; Associate Clinical Professor, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Marwan Odeh
- Associate Clinical Professor, Azrieli Faculty of Medicine, Bar Ilan University, Safed; Head of Obstetrical Ultrasound Unit, Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
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Gilles B, Robergeau FG, Massena LM, Nazaire MK, Millien C. Amniocele associated with placental abruption: a case report. AJOG GLOBAL REPORTS 2023; 3:100270. [PMID: 37868822 PMCID: PMC10587749 DOI: 10.1016/j.xagr.2023.100270] [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] [Indexed: 10/24/2023] Open
Abstract
Amniocele is a rare condition involving herniation of the amniotic sac through a uterine breach. Our case is of a 29-year-old pregnant woman at 31 weeks of pregnancy who presented to the maternity triage of the Mirebalais Teaching Hospital for abdominal pain and the passage of blood through the vagina. After an ultrasonographic evaluation, the diagnosis of amniocele was made. In practice, for a third-trimester, nonlaboring pregnant woman with this symptomatology, the most common diagnoses that come to mind are placenta previa and placental abruption. This case highlights that a diagnosis of silent uterine rupture should also be kept in mind knowing that a uterine rupture is a life-threatening event for both the mother and the fetus, therefore, early diagnosis is very important to improve the maternal-fetal prognosis.
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Affiliation(s)
- Bernard Gilles
- Department of Obstetrics and Gynecology, Mirebalais Teaching Hospital, Mirebalais, Center, Haiti
| | - Fridjof G.S. Robergeau
- Department of Obstetrics and Gynecology, Mirebalais Teaching Hospital, Mirebalais, Center, Haiti
| | - Larry M. Massena
- Department of Obstetrics and Gynecology, Mirebalais Teaching Hospital, Mirebalais, Center, Haiti
| | - Maky-Kenson Nazaire
- Department of Obstetrics and Gynecology, Mirebalais Teaching Hospital, Mirebalais, Center, Haiti
| | - Christophe Millien
- Department of Obstetrics and Gynecology, Mirebalais Teaching Hospital, Mirebalais, Center, Haiti
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Madhuri MS, Jha N, Pampapati V, Chaturvedula L, Jha AK. Fetomaternal outcome of scarred uterine rupture compared with primary uterine rupture: a retrospective cohort study. J Perinat Med 2023; 51:1067-1073. [PMID: 37125850 DOI: 10.1515/jpm-2023-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Literature comparing maternal and perinatal outcomes among women with scarred and primary uterine rupture are limited. Therefore, the study aimed to compare maternal and perinatal outcomes and associated risk factors of uterine rupture among scarred and unscarred uterus. METHODS This retrospective cohort study was performed at a large tertiary care of India between July 1, 2011 and June 30, 2020. We analysed all the cases of complete uterine rupture beyond the 20th week of gestation. The outcome measures were live birth rate, perinatal mortality, maternal mortality and morbidity. RESULTS A total of 115 complete uterine ruptures were noted in 148,102 pregnancies. Of those 115 uterine ruptures, 89 (77.3 %) uterine ruptures occurred in women with a history of caesarean delivery, and 26 (22.6 %) uterine ruptures occurred in primary uterine rupture. The primary uterine rupture group had a significantly higher incidence of lower parity, breech presentation and mean birth weight. The live birth rate (68.18% vs. 42.85 %; p=0.04) was significantly higher in the scarred group, and the stillbirth rate (57.14% vs. 31.86 %; p=0.009) was significantly higher in the primary uterine rupture group. Hypoxic ischemic encephalopathy, APGAR score, and neonatal intensive care unit admission were comparable. Postpartum haemorrhage, blood transfusion, severe acute maternal morbidity and intensive care unit stay were more frequently reported in the primary uterine rupture group. CONCLUSIONS The maternal and perinatal outcomes appear less favourable among women with primary uterine rupture than scarred uterine rupture.
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Affiliation(s)
- Makkam S Madhuri
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Nivedita Jha
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Veena Pampapati
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Latha Chaturvedula
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Ajay Kumar Jha
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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Saleem HA, Albalwi N, Ba'Abbad L. Uterine rupture in a term pregnancy after a previous uterine artery embolization to manage a large fibroid. A case report. Case Rep Womens Health 2023; 39:e00551. [PMID: 37829161 PMCID: PMC10565681 DOI: 10.1016/j.crwh.2023.e00551] [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] [Received: 09/17/2023] [Revised: 09/28/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023] Open
Abstract
Uterine artery embolization (UAE) is an effective minimally invasive alternative to surgery for the treatment of symptomatic uterine fibroids. Uterine rupture is an obstetrical emergency that requires early diagnosis and prompt management to improve perinatal and maternal outcomes. A 33-year-old woman at 37 weeks of gestation who had had previous two uncomplicated vaginal deliveries at term presented with abdominal pain and rupture of membranes. The patient had undergone UAE for the management of a large anterior wall uterine fibroid three years prior to conception. Vaginal examination revealed cord prolapse and ultrasound showed negative fetal heart. Intrauterine fetal demise with cord prolapse was diagnosed. After admission the patient developed vaginal bleeding and features of hypovolemic shock. Urgent laparotomy revealed a ruptured uterus with a large hemoperitoneum and dead fetus in the abdominal cavity. Obstetricians should be attentive to the possibility of a spontaneous uterine rupture in pregnant women who have previously undergone UAE for the management of a uterine fibroid.
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Affiliation(s)
- Heba Abu Saleem
- Department of Obstetrics and Gynaecology, King Abdullah Bin Abdulaziz University Hospital, Saudi Arabia
| | - Nouf Albalwi
- Department of Obstetrics and Gynaecology, King Abdullah Bin Abdulaziz University Hospital, Saudi Arabia
| | - Lina Ba'Abbad
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Princess Nourah Bint Abdulrahman University, Saudi Arabia
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7
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Saleem HA, Edweidar Y, Salim MA, Mahfouz IA. Mid-trimester spontaneous rupture of a bicornuate uterus: A case report. Case Rep Womens Health 2023; 39:e00524. [PMID: 37954229 PMCID: PMC10636261 DOI: 10.1016/j.crwh.2023.e00524] [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: 06/23/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 11/14/2023] Open
Abstract
Bicornuate uterus (BU) is a rare congenital anomaly that may present with various obstetric complications, and very rarely may be a risk factor for uterine rupture, even of an unscarred uterus. A 21-year-old primigravida woman, at 19 weeks and 5 days of gestation, presented with severe abdominal pain and features of hypovolemic shock. Urgent laparotomy showed a large hemoperitoneum, a ruptured left horn of a BU and a dead fetus in the abdominal cavity. Excision of the ruptured left horn was performed and the uterine defect was sutured. Postoperative recovery was uneventful. Bicornuate uterus is a rare uterine anomaly and is associated with various obstetric complications at different gestational ages. Ruptured uterus should be considered in the differential diagnoses of acute abdominal pain and a picture of hypovolemia in women with mid-trimester pregnancies.
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8
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Abdulmane MM, Sheikhali OM, Alhowaidi RM, Qazi A, Ghazi K. Diagnosis and Management of Uterine Rupture in the Third Trimester of Pregnancy: A Case Series and Literature Review. Cureus 2023; 15:e39861. [PMID: 37404397 PMCID: PMC10315010 DOI: 10.7759/cureus.39861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Uterine rupture is associated with clinically significant uterine bleeding, fetal distress, expulsion or protrusion of the fetus, placenta or both into the abdominal cavity requiring prompt cesarean delivery and uterine repair or hysterectomy. Previous cesarean section is the most common risk factor. The most consistent early indicator of it is the onset of prolonged and profound fetal bradycardia. OBJECTIVE In this study, we present six cases of uterine rupture highlighting risk factors, and challenges in diagnosis and management, along with a review of the literature. METHOD A retrospective case series identified eight cases during the five-year study period. All cases from January 1, 2018 to December 31, 2022 were reviewed. Cases with multiple previous cesarean sections were excluded. RESULT Six cases meeting the study criteria were included in our case series. Uterine rupture was a rare occurrence with a prevalence of nine in 31,315 births representing 0.03% of deliveries. No maternal mortality or need for hysterectomy occurred in our study. Fifty percent of uterine ruptures were associated with stillbirths. The most common risk factor was a previous cesarean section in 83.3%. The most common presenting sign was non-reassuring fetal status patterns in 66.6%. A single case had a silent rupture. CONCLUSION Signs and symptoms of uterine rupture are nonspecific making diagnosis challenging. Delay in definitive management causes significant fetal morbidity and mortality. For best outcomes, vaginal birth after a previous cesarean section needs close monitoring in appropriately prepared units with the ability to perform immediate cesarean delivery and provide advanced neonatal support.
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Affiliation(s)
- Mrooj M Abdulmane
- Obstetrics and Gynecology, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Omar M Sheikhali
- Obstetrics and Gynecology, Ibn Sina National College, Jeddah, SAU
| | - Raghad M Alhowaidi
- Obstetrics and Gynecology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Afshan Qazi
- Obstetrics and Gynecology, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Khalid Ghazi
- Obstetrics and Gynecology, King Fahad Armed Forces Hospital, Jeddah, SAU
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9
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Mishra M, Mala YM. Idiopathic spontaneous rupture of unscarred uterus in a primigravida in active labour. Int J Surg Case Rep 2022; 100:107749. [PMID: 36252548 PMCID: PMC9574702 DOI: 10.1016/j.ijscr.2022.107749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction Rupture of unscarred pregnant uterus is a rare occurrence and its incidence is higher in developing countries. Rupture of unscarred uterus is associated higher likelihood of adverse maternal and fetal outcomes. Occurrence of rupture of an unscarred uterus lays foundation for the importance of supervised labour and to maintain a high index of suspicion even in a prim gravida. Case report We present a case of spontaneous rupture of unscarred uterus in a primigravida with no known risk factors. Rupture was diagnosed in second stage of labour when there was cessation of contractions and loss of station. On exploratory laparotomy, hemoperitoneum of 100 ml and a 10 cm tear was found in left posterolateral aspect of uterus. The tear was repaired successfully and patient had a normal post- operative course. Discussion Presence of a uterine scar is the key factor leading to rupture. Spontaneous rupture of unscarred uterus is a rare entity and is associated with multiple factors. In our case, all these factors were ruled out. In literature search we could find 15 cases of spontaneous rupture in unscarred uterus. According to our best knowledge this is the 7th case of rupture in unscarred uterus, reported in a prim gravida without any obvious risk factors. Conclusion Rupture uterus should be kept in mind in all patients, even in primigravida if there is high index of suspicion. Quick diagnosis and immediate laparotomy is the cornerstone of treatment in such cases. Rupture of unscarred uterus is rare but is associated with significant morbidity. High index of suspicion is needed even in absence of risk factors. Immediate laparotomy is the gold standard management. Delay in diagnosis and management can lead foeto-maternal morbidity.
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Affiliation(s)
- Mona Mishra
- Department of Obstetrics and Gynecology, Maulana Azad Medical college and Lok Nayak Hospital, New Delhi, India.
| | - Y M Mala
- Department of Obstetrics and Gynecology, Maulana Azad Medical college and Lok Nayak Hospital, New Delhi, India
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Spontaneous Uterine Rupture and Adenomyosis, a Rare but Possible Correlation: Case Report and Literature Review. Diagnostics (Basel) 2022; 12:diagnostics12071574. [PMID: 35885480 PMCID: PMC9317678 DOI: 10.3390/diagnostics12071574] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Uterine rupture during pregnancy is a serious obstetric complication with a high incidence of maternal morbidity and mortality. (2) Methods: The present case is a rare event of a uterine rupture occurring in an unscarred uterus in a nonlaboring primigravida woman in the second trimester. The only risk factor in this case was adenomyosis found in the preconceptional phase. (3) Results: The diagnosis of adenomyosis can often be difficult, so patients should be evaluated by a specialized gynecologist. After careful amnestic collection, a gynecological examination and II level ultrasound should be performed in accordance with the Morphological Uterus Sonographic Assessment classification. (4) Conclusions: This evaluation allows us to identify classes of patients at high risk of uterine rupture who, therefore, must be properly informed of the risks both during preconceptional counseling and during pregnancy.
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Luke ND, Risseeuw R, Mercado F. Concealed Uterine Rupture in the Broad Ligament in an Unscarred Uterus With Postpartum Hemorrhage. Cureus 2022; 14:e26041. [PMID: 35865436 PMCID: PMC9293276 DOI: 10.7759/cureus.26041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 11/05/2022] Open
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12
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Figueiró-Filho EA, Gomez JM, Farine D. Risk Factors Associated with Uterine Rupture and Dehiscence: A Cross-Sectional Canadian Study. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:820-825. [PMID: 34872139 PMCID: PMC10183935 DOI: 10.1055/s-0041-1739461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To compare maternal and perinatal risk factors associated with complete uterine rupture and uterine dehiscence. METHODS Cross-sectional study of patients with uterine rupture/dehiscence from January 1998 to December 2017 (30 years) admitted at the Labor and Delivery Unit of a tertiary teaching hospital in Canada. RESULTS There were 174 (0.1%) cases of uterine disruption (29 ruptures and 145 cases of dehiscence) out of 169,356 deliveries. There were associations between dehiscence and multiparity (odds ratio [OR]: 3.2; p = 0.02), elevated maternal body mass index (BMI; OR: 3.4; p = 0.02), attempt of vaginal birth after a cesarian section (OR: 2.9; p = 0.05) and 5-minute low Apgar score (OR: 5.9; p < 0.001). Uterine rupture was associated with preterm deliveries (36.5 ± 4.9 versus 38.2 ± 2.9; p = 0.006), postpartum hemorrhage (OR: 13.9; p < 0.001), hysterectomy (OR: 23.0; p = 0.002), and stillbirth (OR: 8.2; p < 0.001). There were no associations between uterine rupture and maternal age, gestational age, onset of labor, spontaneous or artificial rupture of membranes, use of oxytocin, type of uterine incision, and birthweight. CONCLUSION This large cohort demonstrated that there are different risk factors associated with either uterine rupture or dehiscence. Uterine rupture still represents a great threat to fetal-maternal health and, differently from the common belief, uterine dehiscence can also compromise perinatal outcomes.
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Affiliation(s)
- Ernesto Antonio Figueiró-Filho
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Javier Mejia Gomez
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Dan Farine
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Hill MG, Sung WLT, Connolly LR, Dawson TE. Cervical avulsion during induced labour: diagnosis, intraoperative management and postoperative course. BMJ Case Rep 2021; 14:14/10/e244607. [PMID: 34620634 PMCID: PMC8499255 DOI: 10.1136/bcr-2021-244607] [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] [Indexed: 11/04/2022] Open
Abstract
We report the presentation, operative management and follow-up of a 31-year-old nulliparous woman who experienced a cervical avulsion injury (CAI) during labour. The woman was induced with dinoprostone gel, followed by oxytocin infusion and had a prolonged active phase. During the second stage, fetal decelerations were noted and the consultant asked to make a plan for delivery. When assessing to perform a midpelvic instrumental delivery, a cord of tissue was felt below the fetal head. A caesarean delivery was recommended based on this finding. After delivery, injuries to the broad ligament, posterior lower uterine segment vagina and cervix were repaired. The cervix was retained with the intent that some tissue be salvaged. At 6-week follow-up, transvaginal ultrasound confirmed blood flow in the cervical tissue, though cervical insufficiency was suspected on clinical examination. Our findings reinforce the seriousness of CAI and support conservative surgical management as opposed to trachelectomy or hysterectomy.
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Affiliation(s)
- Meghan G Hill
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Wei Lin T Sung
- Obstetrics and Gynaecology, Auckland District Health Board, Auckland, New Zealand
| | - Leanne R Connolly
- Anaesthesiology, Auckland District Health Board, Auckland, New Zealand
| | - Timothy E Dawson
- Obstetrics and Gynaecology, Auckland District Health Board, Auckland, New Zealand
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Spontaneous unscarred uterine rupture in a primigravid patient at 11 weeks of gestation managed surgically: A rare case report. Int J Surg Case Rep 2021; 85:106251. [PMID: 34352624 PMCID: PMC8349754 DOI: 10.1016/j.ijscr.2021.106251] [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: 05/31/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Spontaneous rupture of the primigravid uterus is a rare but catastrophic obstetrical emergency. It usually occurs late in pregnancy or during labour, mainly in multiparous women. But, spontaneous unscarred uterine rupture in a primigravid patient that also in first trimester is very rare. There are only 12 papers in Pub Med database regarding spontaneous unscarred uterine rupture in primigravid in early pregnancy. CASE PRESENTATION A 23-year-old primigravid female at 11th week of pregnancy, with no significant medical or surgical history, presented with sudden onset of generalised abdominal pain for four hours with multiple episodes of vomiting. On physical examination, patient was pale, in haemorrhagic shock with diffuse abdominal tenderness. Ultrasonography showed extra uterine gestational sac with massive haemoperitoneum. Eventually, patient was subjected to emergency laparotomy after resuscitation. CLINICAL DISCUSSION Spontaneous rupture of unscarred gravid uterus is a catastrophic rare condition that can be missed leading to maternal and foetal mortality. There are no pathognomonic features indicating the condition therefore it should be differentiated from other causes of acute abdominal emergencies. CONCLUSION Spontaneous rupture of unscarred gravid uterus should be differentiated from other acute abdominal emergencies. Patient may land up in emergency department in the state of shock, emergency physicians should be aware of its symptoms or presentations.
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15
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Weisshaupt K, Henrich W, Neymeyer J, Weichert A. Mode of delivery of women with Swyer syndrome in a German case series. J Perinat Med 2021; 49:725-732. [PMID: 33725759 DOI: 10.1515/jpm-2020-0562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/16/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES For women with Swyer Syndrome, a 46,XY gonadal dysgenesis, full term pregnancies are possible after oocyte donation. According to literature, mode of delivery is almost always by Caesarean section for various reasons. Medical indications are multiple pregnancies and related complications, preeclampsia, an androgynous shaped pelvis and failed induction of labor. Elective Caesarean sections were performed based on maternal request and medical recommendation. METHODS Following careful examination and shared decision making, we planned a spontaneous delivery with a patient with Swyer syndrome and tested the different hypotheses regarding anatomical and functional features according to literature. In addition, deliveries of women with Swyer Syndrome were analyzed in a German multicenter case series. RESULTS A total of seven women with Swyer syndrome with a total of 10 pregnancies were identified, who later gave birth to twelve live-born children. Seven out of 10 births were performed by elective and non-elective Caesarean section, three births took place vaginally. CONCLUSIONS In summary, the risk of Caesarean section delivery has increased, but spontaneous delivery can be attempted in the event of inconspicuous findings.
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Affiliation(s)
- Karen Weisshaupt
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jörg Neymeyer
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexander Weichert
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Chiossi G, D’Amico R, Tramontano AL, Sampogna V, Laghi V, Facchinetti F. Prevalence of uterine rupture among women with one prior low transverse cesarean and women with unscarred uterus undergoing labor induction with PGE2: A systematic review and meta-analysis. PLoS One 2021; 16:e0253957. [PMID: 34228760 PMCID: PMC8259955 DOI: 10.1371/journal.pone.0253957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As uterine rupture may affect as many as 11/1000 women with 1 prior cesarean birth and 5/10.000 women with unscarred uterus undergoing labor induction, we intended to estimate the prevalence of such rare outcome when PGE2 is used for cervical ripening and labor induction. METHODS We searched MEDLINE, ClinicalTrials.gov and the Cochrane library up to September 1st 2020. Retrospective and prospective cohort studies, as well as randomized controlled trials (RCTs) on singleton viable pregnancies receiving PGE2 for cervical ripening and labor induction were reviewed. Prevalence of uterine rupture was meta-analyzed with Freeman-Tukey double arcsine transformation among women with 1 prior low transverse cesarean section and women with unscarred uterus. RESULTS We reviewed 956 full text articles to include 69 studies. The pooled prevalence rate of uterine rupture is estimated to range between 2 and 9 out of 1000 women with 1 prior low transverse cesarean (5/1000; 95%CI 2-9/1000, 122/9000). The prevalence of uterine rupture among women with unscarred uterus is extremely low, reaching at most 0.7/100.000 (<1/100.000.000; 95%CI <1/100.000.000-0.7/100.000, 8/17.684). CONCLUSIONS Uterine rupture is a rare event during cervical ripening and labor induction with PGE2.
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Affiliation(s)
- Giuseppe Chiossi
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto D’Amico
- Statistics Unit, Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna L. Tramontano
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Veronica Sampogna
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Viola Laghi
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
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Desta M, Kassa GM, Getaneh T, Sharew Y, Alemu AA, Birhanu MY, Yeneabat T, Alamneh YM, Amha H. Maternal and perinatal mortality and morbidity of uterine rupture and its association with prolonged duration of operation in Ethiopia: A systematic review and meta-analysis. PLoS One 2021; 16:e0245977. [PMID: 33886549 PMCID: PMC8062067 DOI: 10.1371/journal.pone.0245977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022] Open
Abstract
Background Uterine rupture is the leading cause of maternal and perinatal morbidity and it accounts for 36% of the maternal mortality in Ethiopia. The maternal and perinatal outcomes of uterine rupture were inconclusive for the country. Therefore, this systematic review and meta-analysis aimed to estimate the pooled maternal and perinatal mortality and morbidity of uterine rupture and its association with prolonged duration of operation. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used for this systematic review and meta-analysis. We systematically used PubMed, Cochrane Library, and African Journals online databases for searching. The Newcastle- Ottawa quality assessment scale was used for critical appraisal. Egger’s test and I2 statistic used to assess the check for publication bias and heterogeneity. The random-effect model was used to estimate the pooled prevalence and odds ratios with 95% confidence interval (CI). Results The pooled maternal mortality and morbidity due to uterine rupture in Ethiopia was 7.75% (95% CI: 4.14, 11.36) and 37.1% (95% CI: 8.44, 65.8), respectively. The highest maternal mortality occurred in Southern region (8.91%) and shock was the commonest maternal morbidity (24.43%) due to uterine rupture. The pooled perinatal death associated with uterine rupture was 86.1% (95% CI: 83.4, 89.9). The highest prevalence of perinatal death was observed in Amhara region (91.36%) and the lowest occurred in Tigray region (78.25%). Prolonged duration of operation was a significant predictor of maternal morbidity (OR = 1.39; 95% CI: 1.06, 1.81). Conclusions The percentage of maternal and perinatal deaths due to uterine rupture was high in Ethiopia. Uterine rupture was associated with maternal morbidity and prolonged duration of the operation was found to be associated with maternal morbidities. Therefore, birth preparedness and complication readiness plan, early referral and improving the duration of operation are recommended to improve maternal and perinatal outcomes of uterine rupture.
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Affiliation(s)
- Melaku Desta
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- * E-mail:
| | - Getachew Mullu Kassa
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Temesgen Getaneh
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Yewbmirt Sharew
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Addisu Alehegn Alemu
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | | | - Tebikew Yeneabat
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- Department of Midwifery, University of Technology Sydney, Sydney, Australia
| | - Yoseph Merkeb Alamneh
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Haile Amha
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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Okaniwa J, Higeta D, Kameda T, Uchiyama Y, Inoue M, Iwase A. Postpartum unscarred uterine rupture caused by placenta accreta: A case report and literature review. Clin Case Rep 2021; 9:1587-1590. [PMID: 33768894 PMCID: PMC7981638 DOI: 10.1002/ccr3.3851] [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] [Received: 07/08/2020] [Accepted: 01/06/2021] [Indexed: 11/05/2022] Open
Abstract
Our case and the literature review suggest that placenta accreta spectrum, with use of uterotonics and manual removal of placenta, could be risk factors for postpartum unscarred uterine rupture.
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Affiliation(s)
- Jun Okaniwa
- Department of Obstetrics and GynecologyGunma University Graduate School of MedicineMaebashiJapan
| | - Daisuke Higeta
- Department of Obstetrics and GynecologyGunma University Graduate School of MedicineMaebashiJapan
| | - Takashi Kameda
- Department of Obstetrics and GynecologyGunma University Graduate School of MedicineMaebashiJapan
| | - Yosuke Uchiyama
- Department of Obstetrics and GynecologyGunma University Graduate School of MedicineMaebashiJapan
| | - Maki Inoue
- Department of Obstetrics and GynecologyGunma University Graduate School of MedicineMaebashiJapan
| | - Akira Iwase
- Department of Obstetrics and GynecologyGunma University Graduate School of MedicineMaebashiJapan
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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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Singla R, Gaba N, Naik AL, Singh A. Rupture of Unscarred Uterus With Intestinal Prolapse From Vagina Following Criminal Abortion. Cureus 2020; 12:e10601. [PMID: 33123421 PMCID: PMC7584304 DOI: 10.7759/cureus.10601] [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] [Indexed: 11/05/2022] Open
Abstract
A 21-year-old unmarried and primigravida female indulged in criminal abortion at 18 weeks of gestation with the help of a village midwife. Instrumentation was done, and it led to uterine perforation with prolapse of 200 cm of small bowel through vagina. She was managed with resection of 160 cm of necrotic small bowel, repair of the uterine defect, and end jejunostomy, which was anastomosed with distal ileum three months later. This case highlights the risks of illegal abortion and the primitive societal mindset that forces unmarried women to resort to such means.
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Affiliation(s)
- Rimpi Singla
- Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Nayana Gaba
- Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Anil L Naik
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Anju Singh
- Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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21
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Bitan R, Wainstock T, Landau D, Sheiner E, Pariente G. Uterine rupture and long-term cardiovascular hospitalization of the offspring. J Matern Fetal Neonatal Med 2020; 35:3276-3283. [PMID: 32933370 DOI: 10.1080/14767058.2020.1818204] [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 Uterine rupture is associated with severely adverse maternal and neonatal outcomes. The association between uterine rupture and long-term cardiovascular hospitalization of the offspring has not been investigated yet. METHODS In a population-based cohort study, the incidence of cardiovascular related hospitalizations was compared between singletons born to mothers with and without uterine rupture in the current pregnancy. Cardiovascular hospitalization up to the age of 18 years was assessed according to a predefined set of ICD-9 codes associated with offspring hospitalization. Multiple gestations, perinatal deaths, lacking prenatal care, and children with congenital malformations or chromosomal abnormalities were excluded from the study. A Kaplan-Meier survival curve was used to assess cumulative incidence of cardiovascular hospitalization of the offspring. A Cox proportional hazards model was performed to control for confounders. RESULTS During the study period, 238,622 newborns met the inclusion criteria, of which 0.053% (n = 127) were born to mothers with uterine rupture in the current pregnancy. Children born to mothers with uterine rupture had significantly higher rates of cardiovascular related hospitalization (Kaplan-Meier's survival curve log-rank test, p=.005). CONCLUSION Being born following uterine rupture is an independent risk factor for long-term pediatric cardiovascular hospitalization. Highlights Uterine rupture is a risk factor for long-term pediatric cardiovascular related hospitalization. Rising rate of CS potentially associate to long-term offspring cardiovascular disease. Cardiovascular surveillance is needed for newborns delivered after uterine rupture.
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Affiliation(s)
- Roy Bitan
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniela Landau
- Department of Pediatrics, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Hochler H, Wainstock T, Lipschuetz M, Sheiner E, Ezra Y, Yagel S, Walfisch A. Grandmultiparity, maternal age, and the risk for uterine rupture-A multicenter cohort study. Acta Obstet Gynecol Scand 2019; 99:267-273. [PMID: 31505021 DOI: 10.1111/aogs.13725] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/30/2019] [Accepted: 09/03/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Uterine rupture is a critical complication causing fetal and maternal morbidity and mortality. Data are conflicting regarding whether grandmultiparity (parity ≥ 6) is a risk factor. This multicenter cohort study aimed to determine whether grandmultiparity (parity ≥ 6) poses a risk for uterine rupture in women with no previous cesarean delivery. MATERIAL AND METHODS A multicenter retrospective study of deliveries that occurred between the years 2003 and 2015 in three tertiary medical centers. Deliveries of grandmultiparous women were compared with those of multiparous women (parity 2-5). Women with previous cesarean deliveries were excluded. Multivariable regression modeling was applied to control for possible confounders. RESULTS A total of 388 784 deliveries of multiparous women with unscarred uteri were recorded during the study period, including 53 965 deliveries of grandmultiparous women and 334 819 deliveries of multiparous women. Grandmultiparous women were significantly older (33.9 ± 5 vs 27.3 ± 5 years; P < 0.0001). Fourteen cases of uterine rupture were recorded in the grandmultiparae group (1 per 3855 labors) vs 41 in the multiparae group (1 per 8166 labors) (odds ratio [OR] 2.07, 95% confidence interval [95% CI] 1.13-3.81; P = 0.030). However, in a multivariable model controlling for maternal age, the association between grandmultiparity and uterine rupture lost its significance (adjusted OR 1.26, 95% CI 0.66-2.41; P = 0.491), and maternal age emerged as an independent predictor of uterine rupture (adjusted OR 1.08, 95% CI 1.04-1.13; P < 0.0001). Additionally, the risk for uterine rupture was elevated in a linear fashion, concomitant with age. CONCLUSIONS Maternal age is a risk factor for uterine rupture. Grandmultiparity does not increase the risk beyond that associated with maternal age.
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Affiliation(s)
- Hila Hochler
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Tamar Wainstock
- School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michal Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.,The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Eyal Sheiner
- Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yossef Ezra
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
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Uterine Rupture on MRI Presenting as Nonspecific Abdominal Pain in a Primigravid Patient with 28-Week Twins Resulting in Normal Neurodevelopmental Outcomes at Age Two. Case Rep Obstet Gynecol 2019; 2019:2890104. [PMID: 31380130 PMCID: PMC6662414 DOI: 10.1155/2019/2890104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/01/2019] [Indexed: 11/17/2022] Open
Abstract
Background Uterine rupture is a rare occurrence that requires a high index of suspicion, particularly in a primigravid patient who presents prior to the onset of labor. Mortality rates are particularly high in primigravid patients. Case A 36-year-old gravida 1, para 0 patient with dichorionic diamniotic twins presented at 28-weeks of gestation with abdominal pain. The pain was initially intermittent and felt to be musculoskeletal in origin. Ultrasound imaging after 3 days of worsening abdominal pain revealed extrauterine fluid, prompting an urgent MRI. MRI diagnosed the uterine rupture with hemoperitoneum and herniation of both amniotic sacs outside of the uterus, including one twin's torso and extremities, prompting emergency cesarean section. The premature twins required 2-month hospitalizations and had no neurodevelopmental impairments at 2-year follow-up. Conclusion We present a unique case of rupture of an unscarred uterus in a primigravid patient prior to the onset of labor. Multiple gestation is a risk factor. This report adds to a handful of cases in which a history of endometriosis or extrauterine pelvic surgery was also present. The use of ultrasound and MRI to evaluate nonspecific abdominal pain led to the diagnosis and survival of both the mother and her premature twins.
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Garland J, Little D. Maternal Death and Its Investigation. Acad Forensic Pathol 2019; 8:894-911. [PMID: 31240079 DOI: 10.1177/1925362118821485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 11/16/2018] [Indexed: 12/26/2022]
Abstract
Maternal deaths are a leading cause of death in young females worldwide, particularly in developing countries. Maternal mortality ratio, the number of maternal deaths per 100 000 live births, averages 240 in developing regions, but only 16 in developed regions. Causes of maternal and pregnancy-related deaths can be subdivided into three broad categories. Direct maternal deaths result from obstetric complications of the pregnant state (i.e., pregnancy, labor, and puerperium) from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above. Indirect maternal deaths result from previously existing diseases or diseases that developed during pregnancy, and which are not due to a direct obstetric cause, but are aggravated by the physiologic effects of pregnancy. Incidental maternal deaths are those from causes unrelated to pregnancy or the puerperium, including accidental deaths and homicide. Maternal deaths carry significant short- and long-term impacts for family members and the role of the pathologist is an important part of the wider knowledge-gathering process that can contribute to changes in maternal mortality rates. This paper reviews the clinical and pathological features of common pregnancy-related disorders and gives guidelines for performing an autopsy related to maternal death.
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Etuk SJ, Abasiattai AM, Ande AB, Omo-Aghoja L, Bariweni AC, Abeshi SE, Enaruna NO, Oladapo OT. Maternal near-miss and death among women with rupture of the gravid uterus: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey. BJOG 2019; 126 Suppl 3:26-32. [PMID: 31050865 DOI: 10.1111/1471-0528.15700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the burden of maternal near-miss and death due to rupture of the gravid uterus, the indicators of quality of care, and avoidable factors associated with care deficiencies for ruptured uterus in Nigerian tertiary hospitals. DESIGN Secondary analysis of a nationwide cross-sectional study. SETTING Forty-two tertiary hospitals. POPULATION Women admitted for pregnancy, childbirth or puerperal complications. METHODS Cases of severe maternal outcome [SMO: maternal near-miss (MNM) or maternal death (MD)] following uterine rupture were prospectively identified over 1 year. MAIN OUTCOME MEASURES Incidence of SMO, indicators of quality of care, and avoidable factors associated with deficiencies in care. RESULTS There were 91 724 live births and 3285 women with SMO during the study period. SMO due to uterine rupture occurred in 392 women: 305 MNM and 87 MD. Uterine rupture accounted for 11.9, 13.3, and 8.7% of all SMO, MNM, and MD, respectively. SMO, MNM, and intra-hospital maternal mortality ratios due to uterine rupture were 4.3/1000 live births, 3.3/1000 live births, and 94.8/100 000 live births, respectively. Mortality index (% of MD/SMO) was 22.2%, and MNM:MD ratio was 3.5. Avoidable factors contributing to deaths were related to patient-orientated problems, especially late hospital presentation and lack of insurance to cover life-saving interventions. Medical personnel problems contributed to care deficiencies in one-third of women who died. CONCLUSION Uterine rupture significantly contributes to SMO in Nigerian tertiary hospitals. Strategies to improve maternal survival should address avoidable institutional factors and include community-based interventions to encourage skilled attendance at birth and early referral of complications. TWEETABLE ABSTRACT Uterine rupture remains an important cause of maternal death in Nigerian tertiary hospitals.
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Affiliation(s)
- S J Etuk
- Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - A M Abasiattai
- Department of Obstetrics and Gynaecology, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - A B Ande
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin-City, Nigeria
| | - L Omo-Aghoja
- Department of Obstetrics and Gynaecology, Delta State University Teaching Hospital, Abraka, Nigeria
| | - A C Bariweni
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Yenagoa, Nigeria
| | - S E Abeshi
- Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - N O Enaruna
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin-City, Nigeria
| | - O T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Mukherjee R, Samanta S. Surgical emergencies in pregnancy in the era of modern diagnostics and treatment. Taiwan J Obstet Gynecol 2019; 58:177-182. [PMID: 30910134 DOI: 10.1016/j.tjog.2019.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2018] [Indexed: 12/30/2022] Open
Abstract
Pregnancy can be complicated with different surgical emergencies which may potentially endanger the mother as well as foetus. In the modern era of advanced diagnostics and treatments, neither of them in response to a surgical emergency in a pregnant woman should be delayed. Appropriate early intervention is essential to decrease the morbidity and mortality. Following article encompasses common surgical emergencies that can arise in a pregnant woman and tries to suggest the approach that may be taken to reduce the burden of morbidity and mortality.
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Al-Zirqi I, Daltveit AK, Vangen S. Maternal outcome after complete uterine rupture. Acta Obstet Gynecol Scand 2019; 98:1024-1031. [PMID: 30762871 DOI: 10.1111/aogs.13579] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/09/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Complete uterine rupture, a rare peripartum complication, is often associated with a catastrophic outcome for both mother and child. However, few studies have investigated large datasets to evaluate maternal outcomes after complete ruptures, particularly in unscarred uteri. This paucity of studies is partly due to the rarity of both the event and the serious outcomes, such as peripartum hysterectomy and maternal death. The incidence of uterine rupture is expected to increase, due to increasing cesarean section rates worldwide. Thus, it is important to have more complete knowledge about the immediate maternal outcome following a complete uterine rupture. The objective was to identify maternal outcomes and their risk factors following complete uterine ruptures. MATERIAL AND METHODS This was a population-based study using data from the Medical Birth Registry of Norway, the Patient Administration System and medical records. Maternities with complete uterine rupture after start of labor in Norway during 1967-2008 (n = 247 births), identified among 2 209 506 women. Uterine ruptures were identified from both registries and were further studied through a review of medical records. Only complete ruptures were included in analysis. The associations between maternal outcomes and demographic and labor risk factors were estimated. Odds ratios (ORs) were determined with crude logistic regressions for each risk factor. Separate multivariable logistic regressions were performed to calculate adjusted odds ratios and 95% confidence intervals (CIs). RESULTS We identified 88 (35.6%) healthy mothers, 107 (43.3%) severe postpartum hemorrhages without hysterectomy, 51 (20.6%) peripartum hysterectomies, and three (1.2%) maternal deaths. Peripartum hysterectomy decreased significantly in the last years of study. Unscarred uterine ruptures significantly increased the risk of peripartum hysterectomy compared with scarred uterine ruptures (AOR 2.6, 95% CI 1.3-5.3). Other factors that increased the risk of peripartum hysterectomy following rupture were: maternal age ≥35 years (AOR 2.3, 95% CI 1.1-5.0), parity ≥3 vs parity 1-2 (AOR 2.8, 95% CI 1.2-6.7), and rupture detection after vaginal delivery (AOR 2.2, 95% CI 1.1-4.8). CONCLUSIONS Unscarred uteri, older maternal age, parity ≥3, and rupture detection after vaginal delivery showed the highest associations with the risk of peripartum hysterectomy after complete uterine rupture.
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Affiliation(s)
- Iqbal Al-Zirqi
- Norwegian National Advisory Unit on Women's Health, Rikshospitalet, Oslo University Hospital, Oslo, Norway.,Women and Children's Division, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Anne Kjersti Daltveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway
| | - Siri Vangen
- Norwegian National Advisory Unit on Women's Health, Rikshospitalet, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Mulot S, Thibon P, Rikelman S, Andre M, Dreyfus M, Benoist G. [Uterine rupture of the unscarred uterus: A report of 10 cases]. ACTA ACUST UNITED AC 2018; 46:692-695. [PMID: 30293949 DOI: 10.1016/j.gofs.2018.09.007] [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: 06/08/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Uterine rupture in the healthy uterus is a rare obstetrical complication, not much suspected and with badly identified risk factors. Thus, there exists frequent delay for treatment and therefore fetal-maternal important morbidity and mortality. This article describes clinical signs and symptoms, management, and maternal and neonatal prognosis of uterine rupture. METHODS Descriptive retrospective study within 13 maternity hospitals, reporting 10 series of cases of uterine rupture on gravid healthy uterus during the third trimester of pregnancy. RESULT The incidence was 2.8/100,000 births. Surgical treatment was conservative in 9 out of 10 cases, the maternal prognosis was good with no maternal deaths and 6 out of 7 patients had at least one subsequent pregnancy. The fetal prognosis was more reserved, with 2 fetal or neonatal deaths and 1 with motor disability. 6/6 patients (100%) had at least one iterative Caesarean section during the following pregnancies with healthy fetuses. CONCLUSION In this series of 10 cases over 25years, maternal-fetal morbidity and mortality were significant, in agreement with the literature. Maternal prognosis remained favorable. When surgical treatment is conservative a subsequent pregnancy is possible and an iterative cesarean section must be performed.
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Affiliation(s)
- S Mulot
- Gynécologie obstétrique, Caen University Hospital, avenue de la Côte-de-Nacre, 14000 Caen, France; Université de Normandie 2, rue des Rochambelles, 14000 Caen, France.
| | - P Thibon
- Réseau périnatalité, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - S Rikelman
- Gynécologie obstétrique, Caen University Hospital, avenue de la Côte-de-Nacre, 14000 Caen, France; Université de Normandie 2, rue des Rochambelles, 14000 Caen, France
| | - M Andre
- Centre hospitalier Flers, rue Eugène-Garnier, 61100 Flers, France
| | - M Dreyfus
- Gynécologie obstétrique, Caen University Hospital, avenue de la Côte-de-Nacre, 14000 Caen, France; Université de Normandie 2, rue des Rochambelles, 14000 Caen, France
| | - G Benoist
- Gynécologie obstétrique, Caen University Hospital, avenue de la Côte-de-Nacre, 14000 Caen, France; Université de Normandie 2, rue des Rochambelles, 14000 Caen, France
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Al-Zirqi I, Daltveit AK, Vangen S. Infant outcome after complete uterine rupture. Am J Obstet Gynecol 2018; 219:109.e1-109.e8. [PMID: 29655964 DOI: 10.1016/j.ajog.2018.04.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/03/2018] [Accepted: 04/06/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Complete uterine rupture is a rare peripartum complication often associated with a catastrophic outcome for both mother and child. However, little has been written based on large data sets about maternal and infant outcome after complete ruptures. This is partly due to the rarity of the event and the serious maternal and infant outcome; it is also partly due to the use of international diagnostic codes that do not differentiate between the less catastrophic partial rupture and more catastrophic complete uterine rupture. As uterine rupture is expected to increase due to increased cesarean delivery rates worldwide, it is important to know more completely about the outcome following complete uterine rupture. OBJECTIVE We sought to explore risk factors associated with poor infant outcome in cases of complete uterine rupture. STUDY DESIGN This population-based study used data from the Medical Birth Registry of Norway, the Patient Administration System, and medical records. We included births with complete uterine rupture after start of labor in all maternity units in Norway during the period 1967 through 2008 (n = 244 births), identified among 2,455,797 births. Uterine ruptures were identified and further studied through a review of medical records. We estimated the associations between infant outcomes and demographic and labor risk factors using logistic regression analyses. Odds ratios with 95% confidence intervals for each risk factor were determined after adjustment for demographic factors and period of birth. The main outcome measure was infant outcome: healthy infant, intrapartum/infant deaths, hypoxic ischemic encephalopathy, and admission to the neonatal intensive care unit. RESULTS We identified 109 (44.7%) healthy infants, 56 (23.0%) infants needing neonatal intensive care unit admission, 64 (26.2%) intrapartum/infant deaths, and 15 (6.1%) infants with hypoxic ischemic encephalopathy. The highest number of intrapartum/infant deaths occurred in 1967 through 1977 (51.6%) and the fewest in 2000 through 2008 (15.0%). Unscarred uterine ruptures did not significantly increase intrapartum/infant deaths compared to scarred uterine ruptures. Placental separation and/or fetal extrusion had the highest odds ratio for intrapartum/infant deaths (odds ratio, 17.9; 95% confidence interval, 7.5-42.4). Time-to-delivery interval <20 minutes resulted in fewest intrapartum/infant deaths (9.9%), although there were 2 deaths at 10-minute interval. Time to delivery >30 minutes vs <20 minutes increased risk of death (odds ratio, 16.7; 95% confidence interval, 6.4-43.5). CONCLUSION Intrapartum/infant death after complete uterine rupture decreased significantly over the decades. Time to delivery >30 minutes and placental separation and/or fetal extrusion had the highest association with intrapartum/infant deaths after complete uterine rupture. Time to delivery <20 minutes limited the incidence of intrapartum/infant deaths.
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Daniel Seow Choon K, Eek Chaw T, Hester Chang Qi QL, Mor Jack NG, Wan Shi T, Kok Hian T. Incidence and contributing factors for uterine rupture in patients undergoing second trimester termination of pregnancy in a large tertiary hospital - a 10-year case series. Eur J Obstet Gynecol Reprod Biol 2018; 227:8-12. [PMID: 29860060 DOI: 10.1016/j.ejogrb.2018.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/12/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Uterine rupture is a rare complication in second trimester termination of pregnancy (TOP) with an overall incidence of up to 1.1%. There are concerns that patients with previous caesarean section(s) were at an increased risk of uterine rupture. However, there is no published data in our local population to date. This study aims to identify the incidence and contributing factors for uterine rupture in women undergoing TOP in Singapore. STUDY DESIGN This is a retrospective review of all women who had TOP between 14+0 weeks to 23+6 weeks gestation from January 2005 to December 2014 in a large tertiary hospital. Patients' characteristics and details of TOP were retrieved from pre-existing hospital databases. The gestation age and dose of gemeprost used were retrieved from an internal hospital audit conducted from December 2012 to July 2016. RESULTS A total of 3385 patients underwent TOP from 2005 to 2014. An estimated 339 patients had a scarred uterus. Seven cases of uterine rupture were identified, with an overall incidence of 0.21% (7/3385). The incidence of uterine rupture in patients with scarred uterus was 2.1% (7/339). Contributing factors identified included higher mean dose of abortifacient, usage of multiple abortifacients and methods, advanced gestation age and short interval between last caesarean section and current TOP. CONCLUSION Second trimester TOP on scarred uterus warrants careful usage of abortifacient with minimal cumulative dosage and should be carried out in early second trimester gestation whenever feasible. Prostaglandin analogues appeared to be safe for TOP in unscarred uteruses.
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Affiliation(s)
- Koh Daniel Seow Choon
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Republic of Singapore.
| | - Tan Eek Chaw
- Division of Obstetrics & Gynecology, KK Women's and Children's Hospital, Republic of Singapore
| | - Qi Lau Hester Chang Qi
- Division of Obstetrics & Gynecology, OBGYN Academic Clinical Program, KK Women's and Children's Hospital, Republic of Singapore
| | - N G Mor Jack
- Division of Obstetrics & Gynecology, OBGYN Academic Clinical Program, KK Women's and Children's Hospital, Republic of Singapore
| | - Tay Wan Shi
- Division of Obstetrics & Gynecology, OBGYN Academic Clinical Program, KK Women's and Children's Hospital, Republic of Singapore
| | - Tan Kok Hian
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, M.Med (O&G), FRCOG, Republic of Singapore
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Posthumus L, Donker ME. Uterine rupture in a primigravid patient, an uncommon but severe obstetrical event: a case report. J Med Case Rep 2017; 11:339. [PMID: 29208037 PMCID: PMC5718063 DOI: 10.1186/s13256-017-1507-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 11/06/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND A spontaneous rupture of the unscarred uterus in a primigravid patient is extremely rare and is associated with high perinatal and maternal morbidity and mortality. CASE PRESENTATION A 34-year-old white primigravid woman, 31 + 3 weeks of gestation, presented with pre-eclampsia and developed a sudden acute abdomen. An emergency laparotomy was performed and a uterine rupture was found as the cause of the event. A stillborn girl was born. CONCLUSION A rupture of the pregnant uterus should always be considered in a pregnant woman presenting with abdominal pain, even in a primigravid patient.
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Affiliation(s)
- Lotte Posthumus
- Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
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de Sá RAM, Pereira de Moraes V, Soares MCDC, Werner H, Ribeiro G, Lopes J, Araujo Júnior E. 3-D Virtual Reconstruction of a Large Amniocele With Protrusion of Legs and Umbilical Cord Following Asymptomatic Uterine Rupture. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:75-77. [PMID: 28760566 DOI: 10.1016/j.jogc.2017.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Complete uterine rupture is a rare and severe intrapartum complication with high rates of maternal and fetal mortality. Asymptomatic uterine rupture is a very rare condition with one unique previous case described in the literature. Three-dimensional virtual models allow an immersive virtual reality of maternal-fetal structures with better understanding by the parents and the medical team. CASE We demonstrate a case of asymptomatic rupture uterine with a large amniocele and protruded legs and umbilical cord at 28 weeks of gestation by using a 3-D virtual model from ultrasound scan data. CONCLUSION 3-D virtual models may be applied to the assessment of obstetric complications, thereby allowing a novel 3-D spatial view of maternal-fetal structures.
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Affiliation(s)
| | | | | | - Heron Werner
- Department of Radiology, Diagnostic Imaging Clinic, Rio de Janeiro, Brazil
| | - Gerson Ribeiro
- Department of Arts and Design, Pontifical Catholic University, Rio de Janeiro, Brazil
| | - Jorge Lopes
- Department of Arts and Design, Pontifical Catholic University, Rio de Janeiro, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
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Ribot E, Gnisci A, Crochet P, Tourette C, d'Ercole C, Agostini A. [Spontaneous uterine rupture at 34weeks gestation in a context of unscarred uterus]. ACTA ACUST UNITED AC 2017; 45:185-186. [PMID: 28708487 DOI: 10.1016/j.gofs.2016.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 12/12/2016] [Indexed: 11/17/2022]
Affiliation(s)
- E Ribot
- Service de gynécologie obstétrique, pôle Parents-Enfants, hôpital de la Conception, université Aix-Marseille-II, boulevard Baille, 13005 Marseille, France
| | - A Gnisci
- Service de gynécologie obstétrique, pôle Parents-Enfants, hôpital de la Conception, université Aix-Marseille-II, boulevard Baille, 13005 Marseille, France
| | - P Crochet
- Service de gynécologie obstétrique, pôle Parents-Enfants, hôpital de la Conception, université Aix-Marseille-II, boulevard Baille, 13005 Marseille, France
| | - C Tourette
- Service de gynécologie obstétrique, pôle Parents-Enfants, hôpital de la Conception, université Aix-Marseille-II, boulevard Baille, 13005 Marseille, France
| | - C d'Ercole
- Service de gynécologie obstétrique, pôle Parents-Enfants, hôpital de la Conception, université Aix-Marseille-II, boulevard Baille, 13005 Marseille, France
| | - A Agostini
- Service de gynécologie obstétrique, pôle Parents-Enfants, hôpital de la Conception, université Aix-Marseille-II, boulevard Baille, 13005 Marseille, France.
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Sturzenegger K, Schäffer L, Zimmermann R, Haslinger C. Risk factors of uterine rupture with a special interest to uterine fundal pressure. J Perinat Med 2017; 45:309-313. [PMID: 27235667 DOI: 10.1515/jpm-2016-0023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 04/19/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE Uterine rupture is a rare but serious event with a median incidence of 0.09%. Previous uterine surgery is the most common risk factor. The aim of our study was to analyze retrospectively women with uterine rupture during labor and to evaluate postulated risk factors such as uterine fundal pressure (UFP). METHODS Twenty thousand one hundred and fifty-two deliveries were analyzed retrospectively. Inclusion criteria were 22 weeks and 0 days-42 weeks and 0 days of gestation, singleton pregnancy and cephalic presentation. Women with primary cesarean section were excluded. A logistic regression analysis adjusting for possible risk factors was conducted and a subgroup analysis of women with unscarred uterus was performed. RESULTS Twenty-eight cases of uterine rupture were identified (incidence: 0.14%). Uterine rupture was noticed in multipara patients only. In the multivariate analysis among all study patients, only previous cesarean section remained a statistically significant risk factor [adjusted odds ration (adj. OR) 12.52 confidence interval (CI) 95% 5.21-30.09]. In the subgroup analysis among women with unscarred uterus (n=19,415) three risk factors were associated with uterine rupture: UFP (adj. OR 5.22 CI 95% 1.07-25.55), abnormal placentation (adj. OR 20.82 CI 95% 2.48-175.16) and age at delivery >40 years (adj. OR 4.77 CI 95% 1.44-15.85). CONCLUSIONS The main risk factor for uterine rupture in the whole study population is previous uterine surgery. Risk factors in women with unscarred uterus were UFP, abnormal placentation, and age at delivery >40 years. The only factor which can be modified is UFP. We suggest that UFP should be used with caution at least in presence of other supposed risk factors.
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Affiliation(s)
- Karin Sturzenegger
- Division of Obstetrics, University Hospital of Zürich, Frauenklinikstrasse 10, 8091 Zürich
| | - Leonhard Schäffer
- Division of Obstetrics, University Hospital of Zürich, Frauenklinikstrasse 10, 8091 Zürich
| | - Roland Zimmermann
- Division of Obstetrics, University Hospital of Zürich, Frauenklinikstrasse 10, 8091 Zürich
| | - Christian Haslinger
- Division of Obstetrics, University Hospital of Zürich, Frauenklinikstrasse 10, 8091 Zürich
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Nitzsche B, Dwiggins M, Catt S. Uterine rupture in a primigravid patient with an unscarred bicornuate uterus at term. Case Rep Womens Health 2017; 15:1-2. [PMID: 29593991 PMCID: PMC5842968 DOI: 10.1016/j.crwh.2017.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 03/18/2017] [Accepted: 03/28/2017] [Indexed: 11/12/2022] Open
Abstract
Background Uterine rupture of an unscarred primigravid uterus is an exceedingly rare event. Cases of spontaneous rupture of an unscarred bicornuate uterus have been reported, but typically occur in the first or second trimester. Case A 28-year-old primigravida at 37 weeks gestation with a known bicornuate uterus and no prior surgery underwent an emergent cesarean section after presenting with severe abdominal pain and signs of fetal compromise. She was found to have a uterine rupture with the fetus free in the abdomen accompanied by a large hemoperitoneum. Both mother and baby did well postoperatively. Conclusion Bicornuate uterus may be an independent risk factor for uterine rupture, which can occur in primigravid patients and at any gestation. A case of uterine rupture in a term primigravid patient is presented. Mullerian anomalies may be an independent risk factor for uterine rupture. A bircornuate uterus warrants a higher index of suspicion for uterine rupture.
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Affiliation(s)
- Brad Nitzsche
- Department of Obstetrics and Gynecology, The University of Illinois College of Medicine in Peoria, Peoria, IL, United States
| | - Maggie Dwiggins
- Department of Obstetrics and Gynecology, The University of Illinois College of Medicine in Peoria, Peoria, IL, United States
| | - Susan Catt
- Department of Obstetrics and Gynecology, The University of Illinois College of Medicine in Peoria, Peoria, IL, United States
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Al-Zirqi I, Daltveit AK, Forsén L, Stray-Pedersen B, Vangen S. Risk factors for complete uterine rupture. Am J Obstet Gynecol 2017; 216:165.e1-165.e8. [PMID: 27780708 DOI: 10.1016/j.ajog.2016.10.017] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 10/09/2016] [Accepted: 10/17/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Complete uterine rupture is a rare peripartum complication associated with a catastrophic outcome. Because of its rarity, knowledge about its risk factors is not very accurate. Most previous studies were small and over a limited time interval. Moreover, international diagnostic coding was used in most studies. These codes are not able to differentiate between the catastrophic complete type and less catastrophic partial type. Complete uterine rupture is expected to increase as the rate of cesarean delivery increases. Thus, we need more accurate knowledge about the risk factors for this complication. OBJECTIVE The objective of the study was to estimate the incidence and risk factors for complete uterine rupture during childbirth in Norway. STUDY DESIGN This population-based study included women that gave birth after starting labor in 1967-2008. Data were from the Medical Birth Registry of Norway and Patient Administration System, complemented with information from medical records. We included 1,317,967 women without previous cesarean delivery and 57,859 with previous cesarean delivery. The outcome was complete uterine rupture (tearing of all uterine wall layers, including serosa and membranes). Risk factors were parameters related to demographics, pregnancy, and labor. Odds ratios for complete uterine rupture were computed with crude logistic regressions for each risk factor. Separate multivariable logistic regressions were performed to calculate the adjusted odds ratios and 95% confidence intervals. RESULTS Complete uterine rupture occurred in 51 cases without previous cesarean delivery (0.38 per 10,000) and 122 with previous cesarean delivery (21.1 per 10,000). The strongest risk factor was sequential labor induction with prostaglandins and oxytocin, compared with spontaneous labor, in those without previous cesarean delivery (adjusted odds ratio, 48.0, 95% confidence interval, 20.5-112.3) and those with previous cesarean delivery (adjusted odds ratio, 16.1, 95% confidence interval, 8.6-29.9). Other significant risk factors for those without and with previous cesarean delivery, respectively, included labor augmentation with oxytocin (adjusted odds ratio, 22.5, 95% confidence interval, 10.9-41.2; adjusted odds ratio, 4.4, 95% confidence interval, 2.9-6.6), antepartum fetal death (adjusted odds ratio, 15.0, 95% confidence interval, 6.2-36.6; adjusted odds ratio, 4.0, 95% confidence interval, 1.1-14.2), and previous first-trimester miscarriages (adjusted odds ratio, 9.6, 95% confidence interval, 5.7-17.4; adjusted odds ratio, 5.00, 95% confidence interval, 3.4-7.3). After a previous cesarean delivery, the risk of rupture was increased by an interdelivery interval <16 months (adjusted odds ratio, 2.3; 95% confidence interval, 1.1-5.4) and a previous cesarean delivery with severe postpartum hemorrhage (adjusted odds ratio, 5.6; 95% confidence interval, 2.4-13.2). CONCLUSION Sequential labor induction with prostaglandins and oxytocin and augmentation of labor with oxytocin are important risk factors for complete uterine rupture in intact and scarred uteri.
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Kathpalia S, Vasudev S, Sinha P, Sandhu N. Spontaneous rupture of unscarred uterus in a primigravida: Unusual cause of postpartum collapse. Med J Armed Forces India 2016; 72:S135-S137. [DOI: 10.1016/j.mjafi.2015.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 10/27/2015] [Indexed: 11/30/2022] Open
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Sayed Ahmed WA, Habash YH, Hamdy MA, Ghoneim HM. Rupture of the pregnant uterus – a 20-year review. J Matern Fetal Neonatal Med 2016; 30:1488-1493. [DOI: 10.1080/14767058.2016.1219997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Weyrich J, Bogdanski R, Ortiz JU, Kuschel B, Schneider KTM, Lobmaier SM. Interdisciplinary Peripartum Management of Acute Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation - a Case Report and Literature Review. Geburtshilfe Frauenheilkd 2016; 76:273-276. [PMID: 27065489 PMCID: PMC4824632 DOI: 10.1055/s-0041-110132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 11/02/2015] [Accepted: 11/22/2015] [Indexed: 01/20/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is increasingly used for the management of acute severe cardiac and respiratory failure. One of the indications is acute respiratory distress syndrome (ARDS) for which, in some severe cases, ECMO represents the only possibility to save lives. We report on the successful long-term use of ECMO in a postpartum patient with recurrent pulmonary decompensation after peripartum uterine rupture with extensive blood loss.
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Affiliation(s)
- J. Weyrich
- Frauenklinik und Poliklinik der Technischen Universität München, München
| | - R. Bogdanski
- Klinik für Anaesthesiologie der Technischen Universität München
| | - J. U. Ortiz
- Frauenklinik und Poliklinik der Technischen Universität München, München
| | - B. Kuschel
- Frauenklinik und Poliklinik der Technischen Universität München, München
| | - K. T. M. Schneider
- Frauenklinik und Poliklinik der Technischen Universität München, München
| | - S. M. Lobmaier
- Frauenklinik und Poliklinik der Technischen Universität München, München
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Sinha M, Gupta R, Gupta P, Rani R, Kaur R, Singh R. Uterine Rupture: A Seven Year Review at a Tertiary Care Hospital in New Delhi, India. Indian J Community Med 2016; 41:45-9. [PMID: 26917873 PMCID: PMC4746953 DOI: 10.4103/0970-0218.170966] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective: To identify the obstetric risk factors, incidence, and causes of uterine rupture, management modalities, and the associated maternal and perinatal morbidity and mortality in one of the largest tertiary level women care hospital in Delhi. Materials and Methods: A 7-year retrospective analysis of 47 cases of uterine rupture was done. The charts of these patients were analyzed and the data regarding demographic characteristics, clinical presentation, risk factors, management, operative findings, maternal and fetal outcomes, and postoperative complications was studied. Results: The incidence of rupture was one in 1,633 deliveries (0.061%). The vast majority of patients had prior low transverse cesarean section (84.8%). The clinical presentation of the patients with rupture of the unscarred uterus was more dramatic with extensive tears compared to rupture with scarred uterus. The estimated blood loss ranged from 1,200 to 1,500 cc. Hemoperitoneum was identified in 95.7% of the patient and 83% of the patient underwent repair of rent with or without simultaneous tubal ligation. Subtotal hysterectomy was performed in five cases. There were no maternal deaths in our series. However, there were 32 cases of intrauterine fetal demise and five cases of stillbirths. Conclusions: Uterine rupture is a major contributor to maternal morbidity and neonatal mortality. Four major easily identifiable risk factors including history of prior cesarean section, grand multiparity, obstructed labor, and fetal malpresentations constitute 90% of cases of uterine rupture. Identification of these high risk women, prompt diagnosis, immediate transfer, and optimal management needs to be overemphasized to avoid adverse fetomaternal complications.
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Affiliation(s)
- Maruti Sinha
- Department of Obstetrics and Gynecology, Kasturba Hospital, New Delhi, India
| | - Ridhima Gupta
- Department of Obstetrics and Gynecology, West Virginia University - Charleston Division, Charleston, West Virginia, USA
| | - Pushpender Gupta
- Department of Radiology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Rekha Rani
- Department of Obstetrics and Gynecology, Kasturba Hospital, New Delhi, India
| | - Ramanjeet Kaur
- Department of Obstetrics and Gynecology, Kasturba Hospital, New Delhi, India
| | - Rahil Singh
- Intern, Sir Ganga Ram Hospital, New Delhi, India
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Haakman O, Ambrose D, Katopodis C, Altman AD. Spontaneous Rupture of an Unscarred Uterus Diagnosed Postpartum: A Case Report. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:1021-4. [PMID: 26629723 DOI: 10.1016/s1701-2163(16)30052-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Uterine rupture is a tear in the uterine wall involving its full thickness, resulting in the formation of a defect in the uterine wall. The major risk factor is the presence of uterine scarring (specifically from Caesarean section), but it can also occur in an unscarred uterus. Although rare, this has been shown to result in more severe complications. CASE A 31-year-old woman, gravida 6 para 6, without prior uterine incision or manipulation developed significant postpartum bleeding. She was found to have a uterine rupture with retroperitoneal extension, and surgical management was required. CONCLUSION Early diagnosis of uterine rupture with rapid initiation of supportive and surgical care may significantly improve prognosis. It is imperative to consider uterine rupture in any obstetrical patient with hemodynamic instability or hemorrhage, regardless of whether risk factors (including a previous uterine scar) are present.
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Affiliation(s)
- Olga Haakman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg MB
| | - Devon Ambrose
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg MB
| | - Christina Katopodis
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg MB
| | - Alon D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg MB; Division of Gynecologic Oncology, University of Manitoba, Winnipeg MB
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Thisted DLA, Mortensen LH, Krebs L. Uterine rupture without previous caesarean delivery: a population-based cohort study. Eur J Obstet Gynecol Reprod Biol 2015; 195:151-155. [PMID: 26544026 DOI: 10.1016/j.ejogrb.2015.10.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 09/30/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine incidence and patient characteristics of women with uterine rupture during singleton births at term without a previous caesarean delivery. STUDY DESIGN Population based cohort study. Women with term singleton birth, no record of previous caesarean delivery and planned vaginal delivery (n=611,803) were identified in the Danish Medical Birth Registry (1997-2008). Medical records from women recorded with uterine rupture during labour were reviewed to ascertain events of complete uterine rupture. Relative Risk (RR) and adjusted Relative Risk Ratio (aRR) of complete uterine rupture with 95% confidence intervals (95% CI) were ascertained according to characteristics of the women and of the delivery. RESULTS We identified 20 cases with complete uterine rupture. The incidence of complete uterine rupture among women without previous caesarean delivery was about 3.3/100,000 deliveries. Multiparity (RR 8.99 (95% CI 1.86-43.29)), induction of labour (RR 3.26 (95% CI 1.24-8.57)), epidural analgesia (RR 10.78 (95% CI 4.25-27.39)), and augmentation by oxytocin (RR 9.50 (95% CI 3.15-28.63)) were associated with uterine rupture. Induction of labour was not significantly related to uterine rupture when adjusted for parity, epidural analgesia and augmentation by oxytocin. CONCLUSION Although uterine rupture is rare, its association with epidural analgesia and augmentation of labour with oxytocin in multipara should be considered. Thus, vigilance should be exercised when labour is obstructed and there is need for epidural analgesia and/or augmentation by oxytocin in multiparous women. Due to the rare occurrence of uterine rupture caution should be exerted when interpreting the findings of this study.
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Affiliation(s)
- Dorthe L A Thisted
- Department of Gynaecology and Obstetrics, University of Copenhagen, Holbaek Hospital, Smedelundsgade 60, 4300 Holbaek, Denmark.
| | - Laust H Mortensen
- Section of Social Medicine, University of Copenhagen, Oester Farimagsgade 5, 1014 Copenhagen, Denmark
| | - Lone Krebs
- Department of Gynaecology and Obstetrics, University of Copenhagen, Holbaek Hospital, Smedelundsgade 60, 4300 Holbaek, Denmark
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Affiliation(s)
- S Okano
- a North Devon District Hospital, Obstetrics & Gynaecology , Raleigh Park, Barnstaple, EX31 4JB , United Kingdom
| | - I Erfan
- a North Devon District Hospital, Obstetrics & Gynaecology , Raleigh Park, Barnstaple, EX31 4JB , United Kingdom
| | - O Eskandar
- a North Devon District Hospital, Obstetrics & Gynaecology , Raleigh Park, Barnstaple, EX31 4JB , United Kingdom
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Vernekar M, Rajib R. Unscarred Uterine Rupture: A Retrospective Analysis. J Obstet Gynaecol India 2015; 66:51-4. [PMID: 27651577 DOI: 10.1007/s13224-015-0769-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 08/13/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Uterine rupture is a catastrophic obstetrical emergency associated with a significant feto-maternal morbidity and mortality. Many risk factors for uterine rupture, as well as a wide range of clinical presentations, have been identified. OBJECTIVES To analyze the frequency, predisposing factors, and maternal and fetal outcomes of uterine rupture. METHODS A retrospective analysis of cases of unscarred uterine rupture was conducted at the Department of Obstetrics and Gynecology, RIMS, Imphal from June 1, 2010 to June 30, 2012. RESULTS Our analysis comprised 13 cases. Of these, 30.8 % were booked cases. Most of the cases (46.2 %) were Para 2. Uterine rupture occurred at term in 10 cases. The rupture occurred due to mismanaged labor (30.8 %), the use of oxytocin (23 %), instrumental delivery (15.4 %), obstructed labor (15.4 %), induction by prostaglandin gel (7.7 %), and placenta percreta (7.7 %). Maternal deaths and perinatal deaths were 30.8 and 53.8 %, respectively. Sub-total hysterectomy was done in 8 cases and in 1 patient laparotomy with repair was performed. CONCLUSION Ruptured uterus causes a high risk in patients. An unscarred uterus can undergo rupture even without etiological or risk factors. The patients with mismanaged labor, grand multiparas, and obstructed prolonged labor must be managed by properly trained personnel at a tertiary care center in order to avoid the morbidity or mortality.
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Affiliation(s)
- Manisha Vernekar
- Department of Obstetrics & Gynaecology, ESI-PGIMSR, ESIC & MC, Joka, Kolkata, India ; c/o Dr Rajib Roy, Plot No 34/1, Pailan Park Housing Project, Pailan, Mouza Daulatpur, P.S-Bishnupur, Kolkata, 700104 India
| | - Roy Rajib
- Department of Obstetrics & Gynaecology, ESI-PGIMSR, ESIC & MC, Joka, Kolkata, India
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Acute uterine rupture in spontaneous term labour in a healthy primigravida: case report and review of the literature. CASE REPORTS IN PERINATAL MEDICINE 2015. [DOI: 10.1515/crpm-2015-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Uterine rupture is an obstetric complication with potential catastrophic fetal and maternal consequences, if not detected early and managed promptly. We report a case of a 32-year-old primigravida in spontaneous labour at term who had unprovoked acute uterine rupture. Operative findings at emergency caesarean section were a live female infant weighing 3150 g requiring resuscitation, massive haemoperitoneum, and large right vertical posterolateral uterine rupture at the upper segment, extending to the ovarian pedicle and down to the vagina vault.
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Gibbins KJ, Weber T, Holmgren CM, Porter TF, Varner MW, Manuck TA. Maternal and fetal morbidity associated with uterine rupture of the unscarred uterus. Am J Obstet Gynecol 2015; 213:382.e1-6. [PMID: 26026917 DOI: 10.1016/j.ajog.2015.05.048] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/10/2015] [Accepted: 05/26/2015] [Indexed: 02/04/2023]
Abstract
OBJECTIVE We sought to report obstetric and neonatal characteristics and outcomes following primary uterine rupture in a large contemporary obstetric cohort and to compare outcomes between those with primary uterine rupture vs those with uterine rupture of a scarred uterus. STUDY DESIGN This was a retrospective case-control study. Cases were defined as women with uterine rupture of an unscarred uterus. Controls were women with uterine rupture of a scarred uterus. Demographics, labor characteristics, and obstetric, maternal, and neonatal outcomes were compared. Primary rupture case outcomes were also compared by mode of delivery. RESULTS There were 126 controls and 20 primary uterine rupture cases. Primary uterine rupture cases had more previous live births than controls (3.6 vs 1.9; P < .001). Cases were more likely to have received oxytocin augmentation (80% vs 37%; P < .001). Vaginal delivery was more common among cases (45% vs 9%; P < .001). Composite maternal morbidity was higher among primary uterine rupture mothers (65% vs 20%; P < .001). Cases had a higher mean estimated blood loss (2644 vs 981 mL; P < .001) and higher rate of blood transfusion (68% vs 17%; P < .001). Women with primary uterine rupture were more likely to undergo hysterectomy (35% vs 2.4%; P < .001). Rates of major composite adverse neonatal neurologic outcomes including intraventricular hemorrhage, periventricular leukomalacia, seizures, and death were higher in cases (40% vs 12%; P = .001). Primary uterine rupture cases delivering vaginally were more likely to ultimately undergo hysterectomy than those delivering by cesarean (63% vs 9%; P = .017). CONCLUSION Although rare, primary uterine rupture is particularly morbid. Clinicians must remain vigilant, particularly in the setting of heavy vaginal bleeding and severe pain.
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Affiliation(s)
- Karen J Gibbins
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT; Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT.
| | - Tiffany Weber
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT; Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT
| | - Calla M Holmgren
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT; Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT
| | - T Flint Porter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT; Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT
| | - Michael W Varner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT; Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT
| | - Tracy A Manuck
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT; Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT
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Saciragic L, Mehdizadeh S, Amankwah Y, Singh S. Spontaneous Uterine Rupture of an Unscarred Uterus in a Twin Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:391. [PMID: 26168097 DOI: 10.1016/s1701-2163(15)30249-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lana Saciragic
- Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa ON
| | | | - Yaa Amankwah
- Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa ON; Faculty of Medicine, University of Ottawa, Ottawa ON
| | - Sukhbir Singh
- Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa ON; Faculty of Medicine, University of Ottawa, Ottawa ON
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Rupture utérine spontanée d’un utérus exempt de cicatrice dans le cadre d’une grossesse gémellaire. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015. [DOI: 10.1016/s1701-2163(15)30250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Berhe Y, Gidey H, Wall LL. Uterine rupture in Mekelle, northern Ethiopia, between 2009 and 2013. Int J Gynaecol Obstet 2015; 130:153-6. [PMID: 25935473 DOI: 10.1016/j.ijgo.2015.02.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 02/01/2015] [Accepted: 04/09/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review cases of uterine rupture at a center in northern Ethiopia. METHODS In a retrospective chart review, data were assessed for cases of symptomatic uterine rupture treated at Ayder Referral Hospital in Mekelle between January 1, 2009, and December 31, 2013. RESULTS In the 5-year study period, there were 5185 deliveries and 47 cases of uterine rupture, giving a rate of one case per 110 deliveries. All patients underwent laparotomy for suspected uterine rupture. Mean parity was 3.6 (range 0-8). The most common predisposing factors were cephalopelvic disproportion (35 [74%] patients), previous cesarean delivery (5 [11%)], and fetal malpresentation (4 [9%]). Hysterectomy was undertaken for 35 (74%) patients; the other 12 (26%) were treated conservatively by simple repair of the rupture. There were 44 (95%) stillbirths and 1 (2%) maternal death. CONCLUSION Uterine rupture remains an important clinical problem in northern Ethiopia. Changes in the cultural preference for home delivery, better transport and referral systems, and improved obstetric training and hospital management of laboring women are needed.
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Affiliation(s)
- Yibrah Berhe
- Department of Obstetrics and Gynecology, Ayder Referral Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Hagos Gidey
- Department of Obstetrics and Gynecology, Ayder Referral Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - L Lewis Wall
- Department of Obstetrics and Gynecology, Ayder Referral Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; Department of Obstetrics and Gynecology, School of Medicine, Washington University in St Louis, St Louis, MO, USA; Department of Anthropology, College of Arts and Sciences, Washington University in St Louis, St Louis, MO, USA.
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