Complete Uterine Rupture Research Articles

Trial of labour after two caesarean sections (TOLA2C) and risk of uterine rupture, a retrospective single centre study

BackgroundMost German hospitals do not offer a trial of labour after two caesarean sections (TOLA2C). TOLA2C is claimed to be associated with too many complications, above all the high risk of uterine rupture. The objective of this study is to review our experience with TOLA2C, with special attention paid to the risk and probability of uterine ruptures. Secondary outcomes include comparing neonatal and maternal outcomes in the group of TOLA2C with the group of elective repeat caesarean section (ERCS) and to assess the success rate for vaginal birth after two caesarean sections (VBAC-2).MethodsThe retrospective cohort study was conducted in a community hospital in North Rhine-Westphalia. Inclusion criteria were all pregnant women with two caesarean sections in their medical history, with a current vertex singleton pregnancy and the absence of morphological abnormalities of the foetus, who gave birth in our facility between January 2015 and June 2021. Descriptive statistics were calculated and Kolmogorov-Smirnov tests, Mann-Whitney U tests, Fishers exact tests, Chi2 –tests and t-tests for independent samples were performed.ResultsA total of 91 cases were included in the TOLA2C-group. These were compared to 99 cases that, within the same time frame, had an elective repeat caesarean section (ERCS-group). There was no statistically significant difference found in the neonatal outcome between the two groups (except for the neonatal pH-value: p 0.024). The hospital stay was significantly shorter in the TOLA2C-group, while maternal complication rates were almost similar (13.2% in the TOLA2C-Group, vs. 16.2% in the ERCS-Group). The success rate for TOLA2C was 55%. No complete uterine rupture was found, but in three cases an incomplete rupture (3.3% rate for incomplete uterine ruptures) occurred, but had no influence on the neonatal outcome.ConclusionTOLA2C is not associated with a worse maternal or neonatal outcome compared to ERCS, and especially the risk of complete uterine ruptures seems to be low. TOLA2C should be more widely offered to suitable patients who are motivated for it.

Complete rupture of the pregnant uterus: A 12-year retrospective study.

To assess the frequency of uterine ruptures, clinical characteristics, and maternal and neonatal outcomes in a tertiary referral center. Information on complete uterine rupture between July 2010 and June 2022 was investigated retrospectively at a tertiary center. There were 42 cases of complete uterine rupture in 144 474 deliveries, with an incidence rate of 0.029%. Twenty-seven cases had a scarred uterus and 15 had an unscarred uterus; Rupture of the lower uterine segment was predominant in the scarred uterus, whereas rupture of the body of the uterus was predominant in the non-scarred uterus (P ≤ 0.001). Newborns with Apgar score of 7 or less at 1 min in the non-scarred uterus group was more than that in the scarred uterus group (P = 0.001). There were no significant differences in the history of gynecologic surgery, induction of labor, mode of delivery, clinical features, maternal outcomes, neonatal weight, preterm birth rate, 5-min Apgar score, or neonatal mortality between the two groups (P > 0.05). The clinical manifestations of uterine rupture are mainly abdominal pain, abnormal fetal heartbeat, or vaginal bleeding. Attention should also be paid to the history of previous uterine surgery. Strict prenatal management, early identification, and aggressive management can help improve maternal and child outcomes. Hysterectomy is not imperative.

Clinical analysis of complete uterine rupture during pregnancy

BackgroundUterine rupture in pregnant women can lead to serious adverse outcomes. This study aimed to explore the clinical characteristics, treatment, and prognosis of patients with complete uterine rupture.MethodsData from 33 cases of surgically confirmed complete uterine rupture at Chenzhou No.1 People’s Hospital between January 2015 and December 2022 were analyzed retrospectively.ResultsIn total, 31,555 pregnant women delivered in our hospital during the study period. Of these, approximately 1‰ (n = 33) had complete uterine rupture. The average gestational age at complete uterine rupture was 31+4 weeks (13+1–40+3 weeks), and the average bleeding volume was 1896.97 ml (200–6000 ml). Twenty-six patients (78.79%) had undergone more than two deliveries. Twenty-five women (75.76%) experienced uterine rupture after a cesarean section, two (6.06%) after fallopian tube surgery, one (3.03%) after laparoscopic cervical cerclage, and one (3.03%) after wedge resection of the uterine horn, and Fifteen women (45.45%) presented with uterine rupture at the original cesarean section incision scar. Thirteen patients (39.39%) were transferred to our hospital after their initial diagnosis. Seven patients (21.21%) had no obvious symptoms, and only four patients (12.12%) had typical persistent lower abdominal pain. There were 13 cases (39.39%, including eight cases ≥ 28 weeks old) of fetal death in utero and two cases (6.06%, both full term) of severe neonatal asphyxia. The rates of postpartum hemorrhage, blood transfusion, hysterectomy were 66.67%, 63.64%, and 21.21%. Maternal death occurred in one case (3.03%).ConclusionsThe site of the uterine rupture was random, and was often located at the weakest point of the uterus. There is no effective means for detecting or predicting the weakest point of the uterus. Rapid recognition is key to the treatment of uterine rupture.

Predicting the risks and recognizing the signs: a two-year prospective population-based study on pregnant women with uterine rupture in The Netherlands

Objective To estimate the incidence of uterine rupture in the Netherlands and evaluate risk indicators prelabour and during labor of women with adverse maternal and/or perinatal outcome. Methods This is a population-based nationwide study using the Netherlands Obstetrics Surveillance System (NethOSS). We performed a two-year registration of pregnant women with uterine rupture. The first year of registration included both women with complete uterine rupture and women with incomplete (peritoneum intact) uterine rupture. The second year of registration included women with uterine rupture with adverse maternal and/or perinatal outcome. We collected maternal and obstetric characteristics, clinical signs, and symptoms during labor and CTG abnormalities. The main outcome measures were incidence of complete uterine rupture and uterine rupture with adverse outcome and adverse outcome defined as major obstetric hemorrhage, hysterectomy, embolization, perinatal asphyxia and/or (neonatal) intensive care unit admission. Results We registered 41 women with a complete uterine rupture (incidence: 2.5 per 10,000 births) and 35 women with uterine rupture with adverse outcome (incidence: 0.9 per 10,000 births). No adverse outcomes were found among women with incomplete uterine rupture. Risk indicators for adverse outcome included previous cesarean section, higher maternal age, gestational age <37 weeks, augmentation of labor, migration background from Sub-Saharan Africa or Asia. Compared to women with uterine rupture without adverse outcomes, women with adverse outcome more often expressed warning symptoms during labor such as abdominal pain (OR 3.34, 95%CI 1.26-8.90) and CTG abnormalities (OR 9.94, 95%CI 2.17-45.65). These symptoms were present most often 20 to 60 min prior to birth. Conclusion Uterine rupture is a rare condition for which several risk indicators were identified. Maternal symptoms and CTG abnormalities are associated with adverse outcomes and time dependent. Further analysis could provide guidance to expedite delivery.

Incidence of Recurrent Uterine Rupture: A Systematic Review and Meta-analysis.

We aimed to quantify the incidence of recurrent uterine rupture in pregnant women. A literature search of PubMed, Web of Science, Cochrane Central, and ClinicalTrials.gov for observational studies was performed from 2000 to 2023. Of the 7,440 articles screened, 13 studies were included in the final review. We included studies of previous uterine ruptures that were complete uterine ruptures , defined as destruction of all uterine layers, including the serosa. The primary outcome was the pooled incidence of recurrent uterine rupture. Between-study heterogeneity was assessed with the I2 value. Subgroup analyses were conducted in terms of the country development status, year of publication, and study size (single center vs national study). The secondary outcomes comprised the following: 1) mean gestational age at which recurrent rupture occurred, 2) mean gestational age at which delivery occurred without recurrent rupture, and 3) perinatal complications (blood loss, transfusion, maternal mortality, and neonatal mortality). A random-effects model was used to pool the incidence or mean value and the corresponding 95% CI with R software. The pooled incidence of recurrent uterine rupture was 10% (95% CI 6-17%). Developed countries had a significantly lower uterine rupture recurrence rate than less developed countries (6% vs 15%, P =.04). Year of publication and study size were not significantly associated with recurrent uterine rupture. The mean number of gestational weeks at the time of recurrent uterine rupture was 32.49 (95% CI 29.90-35.08). The mean number of gestational weeks at the time of delivery without recurrent uterine rupture was 35.77 (95% CI 34.95-36.60). The maternal mortality rate was 5% (95% CI 2-11%), and the neonatal mortality rate was 5% (95% CI 3-10%). Morbidity from hemorrhage, such as bleeding and transfusion, was not reported in any study and could not be evaluated. This systematic review estimated a 10% incidence of recurrent uterine rupture. This finding will enable appropriate risk counseling in patients with prior uterine rupture. PROSPERO, CRD42023395010.

EP20.36: Complete uterine rupture in second trimester

EP20.36: Complete uterine rupture in second trimester

A case of breast milk-acquired cytomegalovirus infection in an extremely low birth weight infant.

Although breast milk is considered the optimal nutrition for infants, it is also the primary cause of postnatal cytomegalovirus (CMV) infection. Preterm infants with postnatal CMV infections are susceptible to a variety of life-threatening conditions. Twin male infants were delivered via emergency caesarian section at 27 weeks' gestation secondary to maternal complete uterine rupture. The Apgar scores at 1 and 5 min were 1 and 1 for the older twin (Twin A) and 0 and 3 for the younger twin (Twin B). Their birth weights were 1203 g (+ 0.65SD) and 495 g (- 3.79SD) respectively. On day 41, laboratory blood test results for Twin B showed a moderate elevation in C-reactive protein (CRP), thrombocytopenia. CMV quantitative polymerase chain reaction (qPCR) tests in Twin B's urine and blood as well as in the mother's breast milk were positive, but stored, dried umbilical cord CMV qPCR tests were negative. Twin B was diagnosed with a postnatal CMV infection secondary to infected breast milk and ganciclovir was commenced on day 52. Treatment was switched to valganciclovir at 74 days of age, but a negative CMV-DNA level in the blood was not achieved. Postnatal CMV infection in this infant led to an exacerbation of pre-existing bronchopulmonary dysplasia (BPD) and he demised at 182 days of age. Postnatal cytomegalovirus infections may lead to exacerbations of BPD. Early use of raw breast milk in preterm infants should be done with careful consideration of this potential complication.

Fetomaternal outcome of scarred uterine rupture compared with primary uterine rupture: a retrospective cohort study.

Literature comparing maternal and perinatal outcomes among women with scarred and primary uterine rupture are limited. Therefore, the study aimed to compare maternal and perinatal outcomes and associated risk factors of uterine rupture among scarred and unscarred uterus. This retrospective cohort study was performed at a large tertiary care of India between July 1, 2011 and June 30, 2020. We analysed all the cases of complete uterine rupture beyond the 20th week of gestation. The outcome measures were live birth rate, perinatal mortality, maternal mortality and morbidity. A total of 115 complete uterine ruptures were noted in 148,102 pregnancies. Of those 115 uterine ruptures, 89 (77.3 %) uterine ruptures occurred in women with a history of caesarean delivery, and 26 (22.6 %) uterine ruptures occurred in primary uterine rupture. The primary uterine rupture group had a significantly higher incidence of lower parity, breech presentation and mean birth weight. The live birth rate (68.18% vs. 42.85 %; p=0.04) was significantly higher in the scarred group, and the stillbirth rate (57.14% vs. 31.86 %; p=0.009) was significantly higher in the primary uterine rupture group. Hypoxic ischemic encephalopathy, APGAR score, and neonatal intensive care unit admission were comparable. Postpartum haemorrhage, blood transfusion, severe acute maternal morbidity and intensive care unit stay were more frequently reported in the primary uterine rupture group. The maternal and perinatal outcomes appear less favourable among women with primary uterine rupture than scarred uterine rupture.

Incidence and outcomes of uterine rupture in women with unscarred, preterm or prelabour uteri: data from the international network of obstetric survey systems.

Analysis of atypical cases of uterine rupture, namely, uterine rupture occurring in unscarred, preterm or prelabour uteri. Descriptive multi-country population-based study. Ten high-income countries within the International Network of Obstetric Survey Systems. Women with unscarred, preterm or prelabour ruptured uteri. We merged prospectively collected individual patient data in ten population-based studies of women with complete uterine rupture. In this analysis, we focused on women with uterine rupture of unscarred, preterm or prelabour ruptured uteri. Incidence, women's characteristics, presentation and maternal and perinatal outcome. We identified 357 atypical uterine ruptures in 3 064 923 women giving birth. Estimated incidence was 0.2 per 10 000 women (95% CI 0.2-0.3) in the unscarred uteri, 0.5 (95% CI 0.5-0.6) in the preterm uteri, 0.7 (95% CI 0.6-0.8) in the prelabour uteri, and 0.5 (95% CI 0.4-0.5) in the group with no previous caesarean. Atypical uterine rupture resulted in peripartum hysterectomy in 66 women (18.5%, 95% CI 14.3-23.5%), three maternal deaths (0.84%, 95% CI 0.17-2.5%) and perinatal death in 62 infants (19.7%, 95% CI 15.1-25.3%). Uterine rupture in preterm, prelabour or unscarred uteri are extremely uncommon but were associated with severe maternal and perinatal outcome. We found a mix of risk factors in unscarred uteri, most preterm uterine ruptures occurred in caesarean-scarred uteri and most prelabour uterine ruptures in 'otherwise' scarred uteri. This study may increase awareness among clinicians and raise suspicion of the possibility of uterine rupture under these less expected conditions.

Comparative analysis of second- and third-trimester complete uterine rupture cases followed up in a tertiary hospital: a retrospective cohort study

Aim: There are not many studies that compared the uterine rupture cases pertaining to different trimesters of pregnancy in terms of the changes in relevant risk factors and fetomaternal outcomes. In this context, this study was carried out to comparatively analyze the cases who were diagnosed with complete uterine rupture and gave birth in the hospital where this study was conducted in terms of the relevant risk factors and fetomaternal outcomes.&#x0D; Material and Method: The population of this retrospective study consisted of patients who were diagnosed with complete uterine rupture and gave birth in our hospital between January 2015 and June 2022. Patients’ demographic characteristics, cesarean section, labor induction histories, and fetal and maternal outcomes were recorded. The patients included in this study were divided into two groups based on the trimester when the complete uterine rupture occurred as second- and third-trimester complete uterine rupture groups. The groups were compared in terms of fetal, maternal, and obstetric outcomes.&#x0D; Results: Out of the 56718 deliveries performed during the study period, a total of 27 complete uterine rupture cases, of whom 10 had second-, and 17 had third-trimester uterine rupture, were included in the study sample. Accordingly, the incidence of rupture was calculated as 0.047%. Of these 27 cases, 9 had re-pregnancy. Bilateral hypogastric artery ligation was performed in seven patients and six of these patients were in the third trimester rupture group. Of the 27 cases with complete uterine rupture, 19 had a cesarean section history. All 8 cases that did not have a cesarean section history had a complete uterine rupture in the third trimester.&#x0D; Conclusion: Complete uterine rupture is associated with adverse maternal and fetal outcomes. Fertility-sparing surgery (primary repair) is the first-line therapy. The prognosis of second-trimester uterine ruptures is more unfavorable compared to third-trimester uterine ruptures from the fetal point of view yet more favorable from the maternal point of view.

Multidisciplinary Healthcare Strategies in Pre-Labor Uterine Rupture after Minimal Invasive Procedures

Uterine rupture is a significant maternal and fetal morbidity and mortality factor. It is defined as the complete cleaving of the three uterine layers. The pregnancy distention leads to alteration of the uterine wall fibers, especially in the low resistance points like surgical scars. World Health Organization realized an extensive systematic review to determine the prevalence of uterine rupture. A lower prevalence was seen in developed countries and higher rates for least developed countries. The incidence of uterine rupture in women with caesarean section is estimated to be 1% and without caesarean section is as low as 0.006%. Although the uterine scar is the main feature of uterine rupture, other contributing influences on untoward outcomes must be promptly recognized. The aim of this paper was to assess the frequency of uterine ruptures in a tertiary referral center, to identify risk factors and symptoms for complete and partial uterine rupture before labor, common symptoms of uterine rupture, multidisciplinary approach, and emergency surgical management.

Assessment of quality of life for affected women singleton pregnancies in Iraq and the diagnosis of pregnancy complications

Uterine rupture occurs when the integrity of the uterine wall is lost. The most common risk factor is having had previous uterine surgery, such as a caesarean section. Uterine rupture is not very frequent, but it is a complication of pregnancy or childbirth that in more serious cases (complete or catastrophic uterine rupture) can cause death of both mother and fetus. Objective: This paper aims to study the assessment of quality of life for affected women singleton pregnancies in Iraq and the diagnosis of pregnancy complications. Patients and Methods: In this study, a descriptive cross-sectional study was applied to study assessment of quality of life for affected women singleton pregnancies in Iraq and the diagnosis of pregnancy complications from 4th July 2021 to 11th June 2022. Data were collected for 90 patients different hospitals in Iraq, where the patients were divided into two groups, the first group of patients, which included women singleton pregnancies patient which included (50), and the second group, control group, which include (40) patients. A statistical study was conducted for women singleton pregnancies patient using the SPSS program. Results and Discussion: Uterine rupture occurs when the uterus ruptures because of pressure during pregnancy, labor or delivery. The uterus can rupture in some or all of its layers, compromising the oxygen supply to the fetus and causing severe bleeding in the mother. Also, Uterine rupture occurs most frequently along the scar line in women who have had previous caesarean sections. Other predisposing factors include congenital uterine abnormalities, trauma and other surgical procedures, and other surgical procedures such as myomectomy or open maternal-fetal surgery where This study relied on the Apgar score distribution of women singleton pregnancies patient, where it was divided into two types of degree and Apgar 5 min &lt; 5 and contained 15 with 30% for the group of women singleton pregnancies patient, but the control group included 27 with 67.5% while Apgar 1 min &lt; 5 was 35 and 70% for the singleton pregnancies patient group and 13, which represented 32.5% with the total number of cases. Conclusion: The incidence of uterine rupture is increasing due to the increase in vaginal deliveries after previous cesarean sections. Our study concludes that the control group was more successful and superior to singleton pregnancies patient group, as a result of what the results of the study showed in evaluating the patients' quality of life as well as the complications affecting both groups.

Outcome of Subsequent Pregnancies in Women With Complete Uterine Rupture: A Population-based Case-control Study

(Acta Obstet Gynecol Scand. 2022;101:506–513) Complete uterine rupture or the rupture of the myometrium occurs in 0.5% of trial of labor after cesarean delivery (TOLAC) births and is related to several adverse events. Few studies regarding the impact of uterine rupture on future delivery have been conducted and have small population sizes. This study aimed to identify later pregnancy outcomes after uterine rupture, identify complications related to the delivery, and compare early pregnancy complications with a control group.

Pregnancies in Women with a Previous Complete Uterine Rupture.

To study the outcomes of new pregnancies after a previous complete uterine rupture. Descriptive study based on population data from the Medical Birth Registry of Norway, the Patient Administration System, and the medical records. Sample. Maternities with a previous complete uterine rupture in Norway during the period 1967-2011 (N = 72), extracted from 2 455 797 maternities. We measured the rate of new complete ruptures and partial ruptures, as well as the maternal and perinatal outcomes of these pregnancies. The characteristics of both previous ruptures and new ruptures were described. Among 72 maternities, there were thirty-seven with previous ruptures in the lower segment (LS) and 35 outside the LS. We found three new complete ruptures and six uneventful partial ruptures, resulting in a rate of 4.2% and 8.3%, respectively. All three complete ruptures occurred preterm in scars outside the LS. The rate of the new complete rupture was 0% in those with previous ruptures in the LS and 8.6% in those with previous ruptures outside the LS. The corrected perinatal mortality was 1.3%, and prematurity (<37 weeks) was high (36.1%); this was noticed even in the absence of new ruptures and was mostly iatrogenic. Two hysterectomies were performed in the absence of rupture and two cases had abnormal invasive placenta. The prognosis for pregnancies after a previous complete uterine rupture is favorable. Prematurity is a problem caused by both obstetrician and mother's anxiety; therefore, the timing of delivery is the most challenging. Management should include careful counseling, vigilance for symptoms, and immediate delivery when a rupture is suspected.

A 10-Year Analysis of Complete Uterine Rupture in Pregnant Women with an Intact Uterus: A Multi-Center Cross-Sectional Study in Sichuan, China

Background: Complete uterine rupture can lead to serious adverse maternal and child outcomes. Uterine rupture is rare, and it can occur in an intact uterus. Methods: We identified patients with intact uterus who encountered uterine rupture between 2010 and 2020 from the medical records of 10 hospitals in Sichuan Province. Results: In total, 37 cases of uterine rupture in intact uteri were identified. Eight ruptures (8/37, 21.6%) occurred before spontaneous labor, 11 ruptures (11/37, 29.7%) occurred during spontaneous labor, and 18 ruptures (18/37, 48.6%) occurred during induced labor. The clinical manifestations of the patients were abdominal pain in 20 cases (20/37, 54.1%), vaginal bleeding in three cases (3/37, 8.1%), and abdominal pain and vaginal bleeding in eight cases (8/37, 21.6%). The rate of hysterectomy/death was significantly higher in patients with more than three previous vaginal deliveries (p = 0.005). In addition, the rate of hysterectomy/death in the spontaneous labor group was significantly higher than that in the induced labor group (p = 0.011). The fetal survival rate in patients with uterine rupture at the uterine horn was significantly higher than that in patients with uterine rupture at the lower uterine segment (p = 0.007). Conclusions: Uterine rupture in an intact uterus was associated with a high hysterectomy rate and high fetal/neonatal mortality rate. For pregnant women with sudden abdominal pain and abnormal fetal heart rate, we should be alert to the possibility of uterine rupture. Induction and augmentation of labor need to be performed with caution to avoid this potential obstetric emergency.

Старые разрывы матки, о которых надо знать

Aim: To review rare cases of uterine rupture that a practitioner may encounter. Key points. Uterine rupture is still a currently relevant issue. Despite the long history of its study and the gradual decrease in the incidence of such cases, uterine rupture remains one of the most severe manifestations of obstetric trauma. In most cases, without timely assistance, a patient with uterine rupture dies. However, there are situations that, seemingly, can be attributed to casuistry, but personal experience as an obstetrician-gynecologist in the 80-s of the last century in one of the African countries and communication with colleagues who had similar cases in their practice suggest the opposite. The article presents four clinical observations, when women lived for a long time with uterine rupture. Conclusion. When analyzing the clinical signs of uterine rupture which occurred during childbirth, attention should be paid to such a pathognomonic sign as termination of labor activity. This symptom has no other explanation than complete uterine rupture, and should be taken into account when monitoring women in labor, even if the pain syndrome is not pronounced, and hemorrhagic shock has not occurred. Keywords: uterine rupture, clinical signs, diagnosis.

Uterine rupture and factors associated with adverse outcomes.

To review cases of uterine rupture and identify risk factors associated with adverse outcomes. This study is a retrospective cohort of complete uterine ruptures diagnosed in a large hospital system in Massachusetts between 2004 and 2018. Baseline demographics, labor characteristics and outcomes of uterine rupture were collected from medical records. A total of 173 cases of uterine rupture were identified. There were 30 (17.3%) women with an unscarred uterus, while 142 (82.1%) had a scarred uterus. Adverse outcomes (n = 89, 51.4% of cases) included 26 (15.0%) hysterectomies, 55 (31.8%) blood transfusions, 18 (10.4%) bladder/ureteral injuries, 5 (2.9%) reoperations, 25 (14.5%) Apgar scores lower than 5 at 5min and 9 (5.2%) perinatal deaths. Uterine rupture of a scarred uterus was associated with decreased risk of hemorrhage (OR 0.40, 95% CI 0.17-0.93), blood transfusion (OR 0.27, 95% CI 0.11-0.69), hysterectomy (OR 0.23, 95% CI 0.08-0.69) and any adverse outcome (OR 0.34, 95% CI 0.13-0.91) compared with unscarred rupture. Uterine rupture during vaginal delivery was associated with increased risk of transfusion (OR 6.55, 95% CI 1.53-28.05) and hysterectomy (OR 8.95, 95% CI 2.12-37.72) compared with emergent C-section. Although rare, uterine rupture is associated with adverse outcomes in over half of cases. Unscarred rupture and vaginal delivery demonstrate increased risk of adverse outcomes, highlighting the need for early diagnosis and operative intervention.

Antepartal Spontaneous Complete Fundal Non-Scarred Uterine Rupture in Twin Pregnancy.

A 31-year-old, otherwise healthy patient (G1/P0) had a history of left salpingectomy for ectopic (tubal) pregnancy followed by diagnostic laparoscopy and uterine septal incision. Because of primary infertility, she underwent assisted reproduction (in vitro fertilization/embryo transfer), which resulted in a bichorial-biamniotic twin pregnancy. The further course was uneventful until 36 weeks when she felt pain in the epigastrium, leading her to be admitted to the hospital under suspicion of epigastric hernia. On admission, cardiotocographic and ultrasound findings showed a normal state of pregnancy with a palpable mobile, painless epigastric formation, without contractions and other symptoms. Two days after admission, she developed sudden pain and acute abdomen without labor, so an urgent laparotomy for suspected uterine rupture was performed, revealing a complete (12 cm) fundal rupture ([Fig. 1]) with prolapsed amniotic sac and twin legs. Live eutrophic twins (2710 g/48 cm, Apgar 10/10; 2790 g/48 cm, Apgar 10/10) were delivered through Kerr’s transverse isthmic hysterotomy, the placenta was removed, and a primary two-layer uterine suture was performed. The postoperative course was complicated by febrile puerperium, which was resolved by antibiotic treatment with complete maternal recovery.

Outcome of subsequent pregnancies post uterine rupture in previous delivery: A case series, a review, and recommendations for appropriate management.

To provide clinicians with concrete solutions on the best management of and counseling for patients in a subsequent pregnancy following uterine rupture. A retrospective analysis of patients treated between 2005 and 2020 at Sheba Medical Center was conducted. All patients who had undergone a complete uterine rupture and subsequently had a full-term pregnancy were included. A literature review was conducted using Pubmed database and including previously published literature reviews. Fifteen patients with subsequent pregnancies following uterine rupture were included in our cohort. Mean interval between rupture and subsequent pregnancy was 3.8 years (range 2.2-6.9 years). One patient had repeat uterine rupture of less than 2cm at 36+5 weeksof pregnancy. A total of 17 studies were selected in this literature review, including a total of 774 pregnancies in 635 patients. The risk of repeated uterine rupture was 8.0% (62/774), ranging from 0% to 37.5%. Overall, the risk of maternal death was of 0.6% (4/635), with only four cases reported in three studies. The risk of recurrence after uterine rupture is significant but should not prevent patients from conceiving.

Autopsies and placental examinations of perinatal fetal deaths: a clinicopathological analysis of 105 cases

Objective: To summarize the clinicopathological factors related to perinatal fetal death and to evaluate importance of fetal autopsy and placental pathology. Methods: The clinicopathological data of 105 perinatal fetal deaths in Beijing Haidian Maternal and Child Health Hospital from November 2012 to December 2020 were retrospectively analyzed. Relevant literature was also reviewed. Results: The maternal age of the deceased fetuses ranged from 22 to 43 years with the average (31.35±4.04 years), and the gestational weeks were 28-40+6 weeks. Among them, 101 were singleton cases and 4 twin cases. 103 fetuses died in uterus and 2 died during delivery. Relevant factors analysis of the 105 perinatal fetal deaths showed that 86 cases (81.9%, 86/105) were related to umbilical cord/placental abnormality, 10 cases (9.5%, 10/105) uterine infection, 6 cases (5.7%, 6/105) fetal factors, 1 case was fetal maternal blood transfusion syndrome, 1 case twin blood transfusion syndrome, and 1 case died of complete uterine rupture. Among the 86 cases related to umbilical cord/placental abnormality, the diagnosis was most often based on the gross examination of placenta. The most common cause of death was umbilical cord torsion with thin root, followed by placental abruption, tight umbilical cord winding, vascular rupture and umbilical cord true knot. The morphology of placenta revealed mainly functional changes. Among the 10 cases related to intrauterine infections, the placenta generally showed lobular placental edema. The morphological characteristics of ascending infection were mainly acute chorioamnionitis, and the morphological characteristics of blood-borne infection were mainly acute or chronic villitis, as well as villous interstitial inflammation. Identification of viral inclusions suggested viral etiology, while the final diagnosis was relied on laboratory testing. Among the 6 cases related to fetal abnormality, the diagnostic value of placenta was limited and the diagnosis could be made with fetal autopsy. Conclusion: The causes of perinatal fetal death are complex, diverse, and often the synergistic result of multiple factors. Fetal autopsy and placental pathology are the key technical means to identify the cause of death and deserve more attention and utilization.