Occurrence Of Uterine Rupture Research Articles

Lessons learned from the perinatal audit of uterine rupture in the Netherlands: A mixed-method study.

Background and AimsTo analyze outcomes of nationwide local audits of uterine rupture to draw lessons for clinical care.MethodsDescriptive cohort study. Critical incident audit sessions within all local perinatal cooperation groups in the Netherlands. Women who sustained uterine rupture between January 1st, 2017 and December 31st, 2019.Main Outcome MeasuresImprovable factors, recommendations, and lessons learned for clinical care. Women's case histories were discussed in multidisciplinary perinatal audit sessions. Participants evaluated care against national and local clinical guidelines and common professional standards to identify improvable factors. Cases and outcomes were registered in a nationwide database.ResultsOne hundred and fourteen women who sustained uterine rupture were discussed in local perinatal audit sessions by 40–60 participants on average: A total of 111 (97%) were multiparous of whom 107 (94%) had given birth by cesarean section in a previous pregnancy. The audit revealed 178 improvable factors and 200 recommendations. Six percent (N = 11) of the improvable factors were identified as very likely and 18% (N = 32) as likely to have a relationship with the outcome or occurrence of uterine rupture. Improvable factors were related to inadequate communication, absent, or unclear documentation, delay in diagnosing the rupture, and suboptimal management of labor. Speak up in case a suspicion arises, escalating care by involving specialist obstetricians, addressing the importance of accurate documentation, and improving training related to fetal monitoring were the most frequent recommendations and should be topics for team (skills and drills) training.ConclusionsThrough a nationwide incident audit of uterine rupture, we identified improvable factors related to communication, documentation, and organization of care. Lessons learned include “speaking up,” improving the transfer of information and team training are crucial to reduce the incidence of uterine rupture.

Outcome of uterine rupture and associated factors in Yirgalem general and teaching hospital, southern Ethiopia: a cross-sectional study

BackgroundThe occurrence of uterine rupture has dropped significantly in high income countries. It continues, however, to be a major public and clinical health problem in low income countries including Ethiopia. Aim of this study was to assess management outcomes of uterine rupture and associated factors in Yirgalem General and Teaching Hospital in South Ethiopia.MethodsInstitution-based cross-sectional study was conducted to examine medical records of women with uterine rupture between January 1, 2012, and Decem”ber 31, 2017. Data were collected based on a checklist. Descriptive statistics and logistic regression analyses were performed.ResultsIncidence of uterine rupture was 345 in 13,500 live births (25.5 in 1000 live births) in the study period. Of these, 331 cases were included. Poor maternal outcome occurred in 224 (67.7%) women. There were 13 (3.7%) maternal deaths and 320 (96.7%) stillbirths. Wound site infection (131; 39.6%) and anemia (129; 39%) were the most common post-operative complications. Prolonged duration of labor (more than 24 h) (adjusted odds ratio (aOR) 3.6; 95% CI 1.7–7.4), women with sepsis on admission (aOR 2.9; 95% CI 1.4–6.1), hemoglobin level < 7 g/dl prior to surgical intervention (aOR 4.5; 95% CI 1.1–17.8), delayed surgical intervention after hospitalization (4 h or more before surgery) (aOR 3.8; 95% CI 1.8–8), women who did not receive blood transfusion (aOR 4.0; 95% CI 2.1–7.9) and prolonged intraoperative time (aOR 5.5; 95% CI 2.8–10.8) were all factors associated with poor maternal outcome of uterine rupture.ConclusionPoor maternal outcome of uterine rupture was high in the study area as compared to other studies. Proper management of anemia, prompt surgical treatment, proper labor progress monitoring, surgical skills, improved infection prevention, maximizing blood transfusion availability and improving the quality of maternal healthcare all play a significant role in reducing uterine rupture and enhancing the chance of good outcomes.

The Impact of Audits of Maternal Deaths and Near Miss at University Hospital of Mother and Child Lagoon (Benin)

Introduction: The maternal deaths audit is one of the three major strategies recommended by WHO for the reduction of maternal and neonatal mortality. Objective: To measure the impact of maternal death and nears miss review on maternal mortality and morbidity after 7 years of practice at the University Hospital of Mother and Child “Lagoon” of Cotonou. Methodology: It was a transversal, descriptive, and analytical study with retrospective data from 1st January 2007 to 31st December 2013. The studied population consisted of maternal deaths cases and of near miss occurred in the hospital during the study period. Results: During the study period, the hospital registered a total of 321 maternal deaths, 3825 perinatal deaths and 3827of near miss. The frequency of maternal death review was 18.7%, the perinatal death of 0.2% and the near miss 0.4%. The most frequent disorders were inadequate reference (69.7%), inadequate treatment (53%), poor supervision (62.1%) and poor files documentation (49.9%). Globally, the period of conducting clinical review was significantly associated with decreased postpartum hemorrhage (p<0.001), pre-eclampsia and eclampsia episodes (p<0.001) and the occurrence of uterine rupture (p=0.02). The occurrence of HRP decreased from 2007 to 2013, but this decrease was not statistically significant (p=0.09). However, there was a significant decrease between 2006 and 2007 (reference period), between 2008 and 2006 and between 2010 and 2006. There is a tendency to lower placenta praevia episodes from 2008-2013 but this decrease does is not statistically significant (p=0.18). Moreover, a significant increase in cases of placenta praevia is observed between 2006 and 2007 (p=0.02). Conclusion: The introduction of maternal death audits is a good approach to reducing maternal mortality and morbidity. However the decrease in indicators of our study can’t be solely attributed to the effect of audits.

Misoprostol for midtrimester termination of pregnancy in women with 1 or more prior cesarean deliveries

ObjectiveTo evaluate the safety and efficacy of vaginal misoprostol for midtrimester termination of pregnancy (TOP) in women with 1 or more prior cesarean deliveries (CDs). MethodsA retrospective study was conducted with 279 women undergoing TOP with vaginal misoprostol between 14 and 26weeks of gestation. Of these, 193 had no uterine scars (group 1), 60 had 1 prior CD (group 2), and 26 had 2 or more prior CDs (group 3). The primary outcome was the success rate of TOP. Secondary outcomes were time from induction to abortion, total dose of misoprostol used, and occurrence of uterine rupture. ResultsThe success rates were 96.4% in group 1, 81.7% in group 2, and 76.9% in group 3 (P=0.001). Time from induction to abortion, total dose misoprostol, and duration of hospital stay differed significantly among the groups (P=0.001 for all variables). There were 3 cases (11.5%) of uterine rupture in group 3, for an overall rate of 1.1%. ConclusionMisoprostol inserted vaginally was effective for midtrimester TOP but the safety of using misoprostol in women with 2 or more prior CDs cannot be confirmed from the present study. Misoprostol should be used carefully, particularly in women with 2 or more prior CDs.

Prognosis prediction of uterine torsion mechanical treatment (rolling) after estimation of calcium and creatinine level in the serum of buffaloes (bubalus bubalis)

The present study was carried out to investigate the relationship between creatinine and calcium concentration in buffalo serum in cases of uterine torsion before rolling, and 1 h and 24 h after calving. The degree, duration and site of uterine torsion, as well as fetus viability, time needed for cervical dilation, and the occurrence of uterine rupture were recorded. A total of 150 pregnant buffaloes suffering from colic and anorexia were brought to our clinic and clinically examined. Of these, 35 buffaloes were diagnosed with uterine torsion (different durations, directions and degrees) and the viability of the foeti and any evidence of uterine rupture were determined using ultrasonography and the serum levels of creatinine and calcium were estimated using calorimetric method. The animals were also examined for incidence of uterine rupture after rolling and calving. The calcium level significantly (P < 0.05) decreased with increasing duration and severity of uterine torsion, however, it was higher in cases where a live fetus was delivered compared with a dead one. Conversely, the creatinine level significantly (P < 0.05) increased with increasing duration and severity of uterine torsion but was lower in cases that delivered a live fetus compared with a dead one. The calcium and creatinine levels returned to approximately normal concentration within 24 h after calving. In conclusion, calcium and creatinine serum concentration have a correlation with duration and severity of uterine torsion. Animals with low levels of calcium (below 8.44 mg/dL) and high levels of creatinine (above 2.25 mg/dL) did not usually respond to rolling or suffer from uterine rupture during calving. The calcium and creatinine levels can be used as indicators for the prognosis of mechanical treatment of uterine torsion in buffaloes.

Obstetric management and outcome of pregnancy in women with a history of caesarean section in the Netherlands

Objective To determine mode of delivery and occurrence of uterine rupture in women with a previous caesarean section (CS) in the Netherlands. Materials and methods During a 1-year period 38 hospitals in the Netherlands registered prospectively mode of delivery, use of prostaglandins or oxytocin and occurrence of uterine rupture in all women with a previous CS. Results There were 4569 women with a previous CS. Trial of labour (TOL) was attempted in 71.7%, of whom 76.0% delivered vaginally. The vaginal birth after caesarean (VBAC)-rate was 54.4%. Forty-nine uterine ruptures occurred (1.1%), of which 48 occurred during a TOL (1.5%). There were four perinatal deaths (1.2/1000 TOL) and 3 hysterectomies (0.9/1000 TOL) related to the rupture. Use of prostaglandin E2 alone or combined with oxytocin was significantly associated with an increased risk of uterine rupture (OR 6.8, 95% CI 3.2–14.3, OR 4.8, 95% CI 1.6–14.6, respectively). The same held for augmentation with oxytocin (OR 2.2, 95% CI 1.04–5.0). Conclusion The success rate of TOL was 76%, resulting in a VBAC rate of 54%. Uterine rupture occurred in 1.5% during a TOL, with a risk of perinatal death of 1.2 per 1000. The risk of uterine rupture increased significantly when labour was induced with prostaglandins alone or combined with oxytocin or when labour was augmented with oxytocin.

Reduction in the occurrence of uterine rupture in Central India

This study was carried out in the Department of Obstetrics and Gynaecology of the Mahatma Gandhi Institute of Medical Sciences, Sevagram in Central India. In the 12 years between 1989 and 2000 a total of 16 cases of ruptured uterus were managed, the incidence of rupture of the pregnant uterus being 0·62 per 1000 births. One-quarter of the cases occurred between 1983 and 1988. No teenager or elderly woman (over 40) or grandmultipara sustained a uterine rupture. Four women had a rupture of a previous scar. In five rupture had occurred in association with malpresentations, one was a case of hydrocephalus, two had a morbidly adherent placenta praevia and four had a normal presentation, with lack of progress in labour. Two of these 16 women had twins. One had come with a retained second twin with transverse lie and the other was a booked case with multiple problems, including a previous caesarean section, present twin pregnancy and placent praevia accreta and she died. This was the only maternal death. Perinatal mortality was 77·77% compared to 5·88% maternal and 100% perinatal mortality in the cases reported previously between 83 and 88, from the same institution. Overall, there is some improvement in perinatal survival and one-quarter incidence of rupture of the pregnant uterus.

Complications of midtrimester pregnancy termination: The effect of prior cesarean delivery

OBJECTIVE: Our purpose was to determine whether a prior cesarean delivery affects the incidence of complications in women having an indicated midtrimester medical pregnancy termination. STUDY DESIGN: A retrospective review of women who underwent a midtrimester medical termination of pregnancy from January 1980 to July 1995 ascertained obstetric history, uterotonic agent(s), and the occurrence of uterine rupture, blood transfusion, or curettage. The frequencies of maternal complications were compared in women with and without a prior cesarean section. RESULTS: Our study population included 606 women with a mean gestational age of 21.1 ± 3.1 weeks and a mean maternal age of 26.3 ± 7 years. Seventy-nine (13%) had undergone a prior cesarean section. There was no significant difference in the need for curettage between women with and without a prior cesarean section. However, there was an increased need for blood transfusions in women with a prior cesarean delivery (11.4% vs 5.3%, odds ratio 2.3, 95% confidence interval 1.1 to 5.0, p = 0.04). The incidence of uterine rupture was significantly higher among women with a prior cesarean (3.8% vs 0.2%, odds ratio 20.8, 95% confidence interval 14.1 to 104, p = 0.008). CONCLUSION: Our data suggest that a prior cesarean section is a risk factor for uterine rupture and blood transfusion in women having a midtrimester pregnancy termination. (Am J Obstet Gynecol 1996;175:889-92.)

A randomised trial of 45 minutes and 15 minutes incremental oxytocin infusion regimes for the induction of labour in women of high parity

To investigate whether in women of high parity induction of labour using a regimen of intravenous oxytocin, increasing incrementally at 45 min intervals, is safer than one increasing at 15 min intervals. University of Benin Teaching Hospital, Department of Obstetrics and Gynaecology, Benin City, Nigeria. Randomised controlled trial. Ninety women of parity 5 or more requiring induction of labour by infusion of oxytocin were randomly allocated to incremental increases at either 45 min intervals (experimental group) or 15 min intervals (control group). Mode of delivery; complications of labour and delivery (uterine rupture, precipitate labour, hyperstimulation, postpartum haemorrhage, perineal tears, puerperal pyrexia); number of days spent in hospital. The 45 min incremental regimen resulted in longer induction-delivery intervals (estimate of difference in population medians 2 h, 95% confidence interval (CI) 1-4 h); less precipitate labour (odds ratio (OR) 0.09, 95% CI 0.03-0.30); less uterine hyperstimulation (OR 0.23, 95% CI 0.09-0.59); and a reduced length of hospital stay (estimate of difference in population medians 3 days, 95% CI 2-5 days). With the 45 min interval regimen there was a reduction in the occurrence of uterine rupture, postpartum haemorrhage, perineal tears and puerperal pyrexia, but these differences did not reach statistical significance. For the induction of labour in women of high parity the infusion rate of oxytocin should be increased every 45 min rather than every 15 min until contractions occur three times in 10 min and this infusion rate of oxytocin is maintained until delivery.