Risk Factors Associated with Uterine Rupture and Dehiscence: A Cross-Sectional Canadian Study.

Ernesto Antonio Figueiró-Filho,Javier Mejia Gomez,Dan Farine

doi:10.1055/s-0041-1739461

Ernesto Antonio Figueiró-Filho, Javier Mejia Gomez + Show 1 more

Open Access

https://doi.org/10.1055/s-0041-1739461

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Abstract

To compare maternal and perinatal risk factors associated with complete uterine rupture and uterine dehiscence. 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. 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. 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.

Highlights

Uterine rupture is defined as complete disruption of all uterine layers during pregnancy, delivery, or immediately after delivery
Risk Factors Associated with Uterine Rupture and Dehiscence Figueiró-Filho et al 821
Our 30-year analysis of uterine rupture in a Canadian population demonstrated that there are different risk factors associated with complete uterine rupture or dehiscence

Summary

Introduction

Uterine rupture is defined as complete disruption of all uterine layers during pregnancy, delivery, or immediately after delivery. It is a catastrophic situation in obstetrics, and, rare, often results in both maternal and fetal adverse consequences.[1,2,3] Uterine rupture can be complete or partial (dehiscence). Complete rupture usually involves direct communication between the uterine cavity and the peritoneum, and is associated with high rates of perinatal mortality and morbidity.[1,2,3] Dehiscence presents when the myometrium is covered by the visceral peritoneum, often an incidental finding in caesarean deliveries, and usually described without any major medical complications.[4,5]. The incidence of uterine rupture ranges between 0.5 and 5.3 per 10 thousand deliveries,[6,7] and mostly happens during trial of labor after a cesarian section (TOLAC).[7,8] Uterine rupture is described in women without a previous cesarian section, during spontaneous onset of labor.[9,10,11] In the Netherlands, this incidence is of around 0.007%.10 Lower incidences were reported in the United States (1/16,849) 12 and in the United Kingdom (0.2/1,000).[11]

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