Clinical characteristics of complete uterine rupture

Abstract

Objective To investigate the current status, clinical features and pregnancy outcome of complete uterine rupture in order to guide the clinical practice. Methods From January 2006 to December 2018, a total of 106 747 parturients who gave birth in West China Second University Hospital, Sichuan University were selected into this study. The prevalence rate, general clinical data, clinical features and pregnancy outcomes of patients with complete uterine rupture were analyzed. This study was in line with the World Medical Association Declaration of Helsinki revised in 2013. Results ① The prevalence rate of complete uterine rupture was 0.038% (41/106 747), of which 0.035% (26/73 369) in 2006-2015 and 0.045% (15/33 378) in 2016-2018. ② Among 41 patients with complete uterine rupture, 22 patients (53.7%) had scar uterus and 19 patients (46.3%) had non-scar uterus. The most common clinical symptom was persistent lower abdominal pain (48.7%, 20/41), the most common clinical signs was abdominal and uterine tenderness (58.5%, 24/41), and fetal heart abnormalities was found in 15.0% (3/20) of patients. ③ All the mothers survived and 6 of them developed complications (14.6%). Hysterorrhaphy was performed in 33 cases (80.5%), total hysterectomy or subtotal hysterectomy was performed in 7 cases (17.1%), removal of rudimentary uterine horn was performed in 1 case (2.4%). ④ In 41 cases of complete rupture of uterus, 27 cases (61.0%) were born alive and 16 cases (39.0%) were stillborn. Among 27 live births, 9 (33.3%) were transferred to pediatrics, 10 (37.0%) had neonatal asphyxia, 8 (29.6%) had mild asphyxia, 2 (7.40%) had severe asphyxia, and 17 had good Apgar scores (1 min after birth). Conclusions The most common risk factors of complete uterine rupture include scarred uterus, placental accreta and increta, history of hysteroscopic surgery. In pregnant women with high-risk factors of complete uterine rupture, persistent abdominal pain or abnormal fetal heart monitoring should be aware of the possibility of uterine rupture, and prompt surgical treatment can improve maternal and infant outcomes. Key words: Uterine rupture; Hysterectomy; Residual uterine pregnancy; Scar uterus; Risk factors; Pregnant women