Abstract
BackgroundCurrently, there are no studies on changes in the incidence of uterine rupture or maternal and foetal outcomes in women with uterine rupture during different birth policy periods in China. Moreover, the results of association studies of maternal age, parity and previous caesarean section number with the risk of maternal and foetal outcomes in women with uterine rupture have not been consistent. This research aims to conduct and discuss the above two aspects.MethodsWe included singleton pregnant women with no maternal complications other than uterine rupture from January 2012 to June 2019 in China’s National Maternal Near Miss Surveillance System. The data in this study did not differentiate between complete and partial uterine rupture and uterine dehiscence. Through Poisson regression analysis with a robust variance estimator, we compared the incidences of uterine rupture and maternal and foetal outcomes in women with uterine rupture during different birth policy periods in China and determined the relationship between maternal age, parity or previous caesarean section number and uterine rupture or maternal and foetal outcomes in women with uterine rupture.ResultsThis study included 8,637,723 pregnant women. The total incidences of uterine rupture were 0.13% (12,934) overall, 0.05% during the one-child policy, 0.12% during the partial two-child policy (aRR = 1.96; 95% CI: 1.53–2.52) and 0.22% (aRR = 2.89; 95% CI: 1.94 4.29) during the universal two-child policy. The maternal near miss and stillbirth rates in women with uterine rupture were respectively 2.35% (aRR = 17.90; 95% CI: 11.81–27.13) and 2.12% (aRR = 4.10; 95% CI: 3.19 5.26) overall, 5.46 and 8.18% during the first policy, 1.72% (aRR = 0.60; 95% CI: 0.32–1.17) and 2.02% (aRR = 0.57; 95% CI: 0.37–0.83) during the second policy, and 1.99% (aRR = 0.90; 95% CI: 0.52–1.53) and 1.04% (aRR = 0.36; 95% CI: 0.24–0.54) during the third policy. The risk of uterine rupture increased with parity and previous caesarean section number.ConclusionThe uterine rupture rate in China continues to increase among different birth policy periods, and the risk of maternal near miss among women with uterine rupture has not significantly improved. The Chinese government, obstetricians, and scholars should work together to reverse the rising rate of uterine rupture and improve the pregnancy outcomes in women with uterine rupture.
Highlights
There are no studies on changes in the incidence of uterine rupture or maternal and foetal outcomes in women with uterine rupture during different birth policy periods in China
Changes in the uterine rupture rate in China under different birth policy periods From January 2012 to June 2019, a total of 12,934 cases of uterine rupture occurred among 8,637,723 singleton pregnant women, with a rupture rate of 0.13% (Table 2)
Compared with that during the period of the one-child policy, which was 0.05%, the rate of uterine rupture increased by 0.12% and 0.22% during the periods of the partial two-child policy and universal two-child policy
Summary
There are no studies on changes in the incidence of uterine rupture or maternal and foetal outcomes in women with uterine rupture during different birth policy periods in China. The results of association studies of maternal age, parity and previous caesarean section number with the risk of maternal and foetal outcomes in women with uterine rupture have not been consistent. Uterine rupture is an obstetric disease that is closely related to maternal reproductive characteristics The changes in these reproductive characteristics may affect the uterine rupture incidence and maternal and neonatal outcomes. There is no research report on the incidence of uterine rupture or the changes in maternal and foetal outcomes in women with uterine rupture under the different birth policies
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