Abstract
Background and Objectives: Since spontaneous uterine rupture in the mid-trimester is rare, maternal and fetal outcomes in subsequent pregnancies remain unclear. Therefore, this study aimed to examine the maternal and fetal outcomes of subsequent pregnancies after prior mid-trimester uterine rupture. Materials and Methods: A systematic review using PubMed, the Cochrane Central Register of Controlled Trials, and Scopus until 30 September 2021, was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The studies that clarified the maternal and fetal outcomes after prior mid-trimester uterine rupture and our case (n = 1) were included in the analysis. Results: Among the eligible cases, there were five women with eight subsequent pregnancies after prior mid-trimester uterine rupture. The timing of prior mid-trimester uterine rupture ranged from 15 to 26 weeks of gestation. The gestational age at delivery in subsequent pregnancies was 23–38 gestational weeks. Among the included cases (n = 8), those involving prior mid-trimester uterine rupture appeared to be associated with an increased prevalence of placenta accreta spectrum (PAS) (n = 3, 37.5%) compared with those involving term uterine rupture published in the literature; moreover, one case exhibited recurrent uterine rupture at 23 weeks of gestation (12.5%). No maternal deaths have been reported in subsequent pregnancies following prior mid-trimester uterine rupture. Fetal outcomes were feasible, except for one pregnancy with recurrent mid-trimester uterine rupture at 23 weeks of gestation, whose fetus was alive complicated by cerebral palsy. Conclusions: Our findings suggest that clinicians should be aware of the possibility of PAS and possible uterine rupture in pregnancies after prior mid-trimester uterine rupture. Further case studies are warranted to assess maternal and fetal outcomes in pregnancies following prior mid-trimester prior uterine rupture.
Highlights
Uterine rupture is potentially catastrophic for the mother and fetus [1,2], with an incidence of 5.9/10,000, and predominantly occurs during the intrapartum period and rarely before labor [1,3]
We report a case of a woman with placenta accreta spectrum (PAS) following spontaneous uterine rupture at 15 weeks’ gestation, and this case was included in the analysis
Since our patient did not meet any of the criteria for uterine rupture in an unscarred uterus, we considered the prior cesarean delivery to be the cause of uterine rupture in the mid-trimester
Summary
Uterine rupture is potentially catastrophic for the mother and fetus [1,2], with an incidence of 5.9/10,000, and predominantly occurs during the intrapartum period and rarely before labor [1,3]. The primary risk factor for uterine rupture is prior cesarean delivery, and the estimated incidence of rupture is higher in women who undergo a trial of labor after cesarean delivery (TOLAC) than in those who undergo planned repeat cesarean delivery (PRCD) (0.78% with TOLAC versus 0.02% with PRCD) [4]. A study published in 2020 (n = 37) demonstrated no recurrent uterine rupture in subsequent pregnancies after prior uterine rupture in cases where cesarean delivery was performed between 36 and 37 weeks of gestation [6]. Since spontaneous uterine rupture in the mid-trimester is rare, maternal and fetal outcomes in subsequent pregnancies remain unclear. This study aimed to examine the maternal and fetal outcomes of subsequent pregnancies after prior mid-trimester uterine rupture. Further case studies are warranted to assess maternal and fetal outcomes in pregnancies following prior mid-trimester prior uterine rupture
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