Maternal and Perinatal Outcomes of Complete Uterine Rupture: A Multicenter Retrospective Cohort Study in China

Abstract

Background: Complete uterine rupture (CUR) is a rare but severe obstetric complication. We explored the characteristics of CUR and compared the maternal and perinatal outcomes of different types of CUR. Methods: This was a hospital-based multicenter retrospective cohort study. We consecutively enrolled women with surgically confirmed CUR from 22 tertiary hospitals in China between January 1, 2004 and January1, 2019. CUR patients were divided into CS (cesarean section)-scarred, non-CS-scarred and unscarred groups. Characteristics and outcomes of CUR patients were compared appropriately. Findings: There were 201 women with CUR. CS-scarred CUR was the most common type (130, 64.7%), followed by unscarred CUR (47, 23.4%) and non-CS-scarred CUR (24, 12%). CUR resulted in 4 maternal deaths (2%).An increase in severe postpartum hemorrhage was observed in the following order: CS-scarred CUR < non-CS-scarred CUR< unscarred CUR. There were 210 fetuses and newborns including 9 twins. The fetal and perinatal mortality rates were 31% and 24.3% respectively. 25 of the newborns had severe neonatal asphyxia, and 74 newborns required NICU admission. 13 infants were diagnosed with hypoxic ischemic encephalopathy. Increases in fetal death, perinatal death and NICU admission were observed in the following order: CS-scarred CUR < non-CS-scarred CUR < unscarred CUR. Interpretation: The maternal and perinatal mortality rates are slightly higher in China than in Western countries. Unscarred CUR and non-CS-scarred CUR are associated with higher risks of adverse maternal and perinatal outcomes than CS-scarred CUR. Identification of the rupture type is helpful for clinical decision-making. Funding: CAMS initiative for Innovative Medicine (CAMS-12 M; 2017-12M-1-002) Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study used only medical records data, and it was approved by the institutional review board of PUMCH.