Rate Of Uterine Rupture Research Articles

High rate of uterine rupture in a conflict setting of Hajjah, Yemen

A descriptive study was conducted to investigate the epidemiology and the outcome of uterine rupture at Hajjah Hospital, Yemen, during September 2014–August 2016. There were 110 cases of ruptured uterus and 3457 deliveries (31.8 per 1000 delivery). The majority (82, 74.5%) of these patients were illiterate. One hundred and four (96.3%) of them had no antenatal care. Seventy-eight of these women (70.9%) delivered at home and 32 (29.1%) delivered at hospital. Out of these 110 cases, 74 (67.3%) and 36 (32.7%) had unscarred uterus and scarred uterus, respectively. The causes of ruptured uterus were as follows: obstructed labour 59 (53.6%), previous caesarean delivery 36 (32.7%), use of oxytocin 10 (9.1%) and misoprostol 5 (4.6%). Hysterectomy was carried out in 50 (45.4%) %), repair in 39 (35.4%), repair with tubal ligation in 18 (16.4%) patients and 3 (2.7%) patients died before operation. There was 8 (7.2%) and 101 (91.8%) maternal and perinatal mortality, respectively. Nineteen (17.3%), 6 (5.4%) and 2 (1.8%) women developed sepsis, had urinary bladder injury and developed vesicovaginal fistulae, respectively.

Maternal and neonatal morbidity: repeatCesarean versus atrial of labour after previousCesareandelivery.

The purpose of this study was to perform a meta-analysis comparing the rates of uterine rupture, and other maternal and neonatal complications, between women who undergo a trial of labour (TOL) after a prior Cesarean delivery and those to undergo elective repeat Cesarean delivery (ERCD). Medline, Cochrane, EMBASE and Google Scholar were searched until May 6, 2015 using the keywords/phrases: trial of labour, Cesarean section, elective, repeat, pregnancy and vaginal birth. Randomized controlled trials (RCTs), two-arm prospective studies, one-arm studies and retrospective studies were included. The primary outcome was uterine rupture. Sixteen studies were included in the meta-analysis. TOL after prior Cesarean delivery was associated with higher odds of uterine rupture as compared with ERCD (Peto odds ratio [OR] = 4.685, 95% confidence interval [CI]: 3.077 to 7.133, p < 0.001). TOL was associated with a higher rate of endometritis, a lower rate of hysterectomy, and a lower rate of respiratory problems in newborns. There were no differences between the groups with respect to neonatal intensive care unit admissions, postpartum hemorrhage, thromboembolic disease, sepsis and neonatal mortality. TOL may be associated with a higher risk of uterine rupture and endometritis, but lower risk of hysterectomy and neonatal respiratory problems than ERCD.

Epidural analgesia at trial of labor after cesarean (TOLAC): a significant adjunct to successful vaginal birth after cesarean (VBAC).

Epidural analgesia has been considered a risk factor for labor dystocia at trial of labor after cesarean (TOLAC) and uterine rupture. We evaluated the association between exposure to epidural during TOLAC and mode of delivery and maternal-neonatal outcomes. A single center retrospective study of women that consented to TOLAC within a strict protocol between 2006 and 2013. Epidural "users" were compared to "non-users". Primary outcome was the mode of delivery: repeat in-labor cesarean or vaginal birth after cesarean (VBAC). Secondary outcomes were maternal/neonatal morbidities. Univariate/multivariate analyses for associations between epidural and mode of delivery were adjusted for significant covariates/mediators. Of a total of 105,471 births registered, 9464 (9.0%) were eligible for TOLAC; 7149 (75.5%) women consented to TOLAC, among which 4081 (57.1%) had epidural analgesia. The in labor cesarean rate was significantly lower for the epidural "users" 8.7% vs. "non-users" 11.8%, P<0.0001, with a parallel increased rate of instrumental delivery. Uterine rupture rates were comparable: 0.4% and 0.29%, respectively (P=0.31). The adjusted multivariate model showed that epidural "users" were more likely to experience a VBAC, odds ratio (OR) 4.58 [3.67; 5.70]; P<0.0001 with a similar rate of adverse maternal-neonatal outcomes. Epidural analgesia at TOLAC may emerge as a safe and significant adjunct for VBAC.

Labor after cesarean delivery managed without induction or augmentation of labor.

This study aimed to describe the perinatal outcomes of women opting for vaginal birth after cesarean delivery (VBAC) managed without induction or augmentation of labor. This was a retrospective cohort study of candidates for VBAC at a tertiary center in Japan from April 2003 to March 2012. Women with singleton gestations and one prior low-transverse cesarean delivery who intended VBAC at 36weeks of gestation were identified as candidates for VBAC and included in the study. Participants were managed without induction or augmentation of labor. Maternal characteristics and perinatal outcomes were obtained from medical records. Factors associated with successful VBAC were analyzed with a multivariable logistic regression model. Of 333 candidates for VBAC, 242 (72.7%) had vaginal birth, 49 (14.7%) had repeat cesarean delivery with spontaneous labor, and 42 (12.6%) had repeat cesarean delivery without spontaneous labor. The rate of uterine rupture was 0.3% (1/333). Prior vaginal delivery and nonrecurring indications for prior cesarean delivery were associated with successful VBAC. Management of candidates for VBAC without induction or augmentation of labor resulted in a high VBAC rate and favorable perinatal outcomes. Such restrictive VBAC policies may be an acceptable alternative to standard management or abandonment of VBAC.

The Cost-effectiveness of a Trial of Labor After Two Prior Cesareans: Impact on the Subsequent Pregnancy [29Q

INTRODUCTION: The benefits of a trial of labor (TOL) after a single cesarean are generally accepted; this is not true regarding a TOL following two cesareans. Since mode of delivery in the index pregnancy will affect the outcomes in the subsequent pregnancy, we designed a model to examine the cost-effectiveness of a TOL vs elective repeat cesarean (eRCD). METHODS: A decision-analytic model was built using TreeagePro and incorporated probabilities, costs, and utilities from the literature. This model was applied to a theoretical cohort of 100,000 women in order to assess the clinical outcomes of uterine rupture, maternal/perinatal death, and neonatal short/long-term disability in both the index and subsequent pregnancy (including future incidence of previa/accreta). A cost-effectiveness threshold was set to $100,000 per quality-adjusted life year, and the robustness of the model was assessed with sensitivity analyses. RESULTS: In our model, a TOL following 2 cesareans resulted in 46 fewer maternal demises, 65 additional perinatal demises, and 8 additional cases of cerebral palsy. eRCD resulted in 173 additional cases of placenta previa and 137 cases of placenta accreta. A TOL conferred a cost savings of $3,837 per pregnancy, and was the cost-effective strategy up to a rate of uterine rupture during TOL of 4.4% and down to a successful TOL rate of 20.2%. CONCLUSION: When including the outcomes of both the index and subsequent pregnancy, a TOL following two previous cesareans is the cost-effective delivery strategy. Careful counseling regarding the increased rates of neonatal complications (despite an overall low absolute risk) must be addressed.

Association between prior vaginal birth after cesarean and subsequent labor outcome

Objective: To estimate the effect of prior successful vaginal birth after cesarean (VBAC) on the rate of uterine rupture and delivery outcome in women undergoing labor after cesarean. Methods: A retrospective cohort study of all women attempting labor after cesarean delivery in a university-affiliated tertiary-hospital (2007–2014) was conducted. Study group included women attempting vaginal delivery with a history of cesarean delivery and at least one prior VBAC. Control group included women attempting first vaginal delivery following cesarean delivery. Primary outcome was defined as the rate of uterine rupture. Secondary outcomes were delivery and maternal outcomes. Results: Of 62,463 deliveries during the study period, 3256 met inclusion criteria. One thousand two hundred and eleven women had VBAC prior to the index labor and 2045 underwent their first labor after cesarean. Women in the study group had a significantly lower rate of uterine rupture 9 (0.7%) in respect to control 33 (1.6%), p = .036, and had a higher rate of successful vaginal birth (96 vs. 84.9%, p < .001). In multivariate analysis, previous VBAC was associated with decreased risk of uterine rupture (OR = 0.46, 95% CI 0.21–0.97, p = .04). Conclusions: In women attempting labor after cesarean, prior VBAC appears to be associated with lower rate of uterine rupture and higher rate of successful vaginal birth.

Trial of labour after caesarean section: Two-year analysis at a Portuguese centre

We conducted a retrospective study aimed at determining variables associated with a higher success rate for vaginal delivery after caesarean section, and assessing the impact of induction of labour. Secondarily, we aimed to describe our vaginal delivery and uterine rupture rates with the use of a controlled-release dinoprostone vaginal insert for cervical ripening. Of 292 women who met the inclusion criteria, induction of labour occurred in 48% (94% with dinoprostone). There was a non-significant difference between the vaginal delivery rate of spontaneous labour (57%) and induction of labour (33%), after adjusting for confounding variables. The success rate was influenced by a Bishop score ≥6, previous vaginal delivery and previous caesarean for dystocia or failed induction. There was only one case of uterine rupture, which was associated with dinoprostone use (overall rate 0.34%, 0.77% for dinoprostone).Impact statementTrial of labour after caesarean section is considered an alternative to elective repeat caesarean.Both present associated benefits and risks, the most fearsome of which is uterine rupture during labour (0.78% in term pregnancies).Induction is also possible but carries a higher risk of uterine rupture and lower success rate for vaginal birth. Prostaglandins have been of particular concern due to a higher risk of uterine scar rupture, estimated at 2% for dinoprostone; however, its use as a controlled-release vaginal insert has been under-reported.Our study confirms the reported impact of previous vaginal delivery, previous caesarean indication and Bishop score at admission on success rate for vaginal birth after caesarean.We were unable to prove a lower success rate for induction of labour after adjusting for other variables. Despite our study limitations, we report on the use of a controlled-release vaginal insert with 10mg of dinoprostone in 130 women with a uterine rupture rate of 0.77%, lower than previously reported and similar to the overall rate estimated for term pregnancies.This dinoprostone formulation may be safer than previously reported but larger studies, and preferably randomised controlled trials, are needed to confirm these findings.

Uterine rupture after previous low segment transverse cesarean is rarely catastrophic

Objective: The cornerstone of concerns over trial of labor after cesarean (TOLAC) is the risk of uterine rupture. The purpose of this study was to document the rate of uterine rupture during TOLAC and to delineate its severity and consequences.Materials and methods: We retrospectively collected the data on vaginal and cesarean deliveries after a previous cesarean section with specific emphasis on uterine rupture and dehiscence in our center from 2006 through 2013.Results: 22,670 deliveries were registered, with 18.2% rate of cesarean section. 2890 women had a single cesarean scar; of them 1206 delivered vaginally and 194 were re-operated during unsuccessful TOLAC. Seven cases of uterine rupture and 16 cases of dehiscence were recorded. There were no maternal, intrapartum or neonatal deaths, and no cesarean hysterectomy. There was one re-laparotomy, one ICU admission, and one blood transfusion; one neonate was admitted to NICU. TOLAC was successful in 86.1% of cases.Conclusions: Cautious selection and close monitoring of candidates are the cornerstones of successful management of TOLAC. Readily available facilities for emergency cesarean delivery and concerted obstetrical team can save the mother and child from catastrophic complications.

Uterine Rupture: Trends Over 40 Years

(BJOG. 2016;123:780–787) An increasing trend in the use of cesarean section worldwide implies a consequent increase in the rate of uterine rupture. The objectives of this study were to determine the trends in incidence, risk factors, and outcomes of uterine rupture over a period of 40 years in Norway.

Uterine Suspension With Adjustable Sutures for Difficult Laparoscopic Myomectomy

Study ObjectiveTo assess whether transabdominal uterine suspension with adjustable sutures (USAS) is beneficial when performed concomitantly with laparoscopic myomectomy in patients with unfavorably localized leiomyomas in whom uterine manipulators are not an option. DesignA retrospective cohort study (Canadian Task Force classification II-2). SettingA university teaching hospital. PatientsPatients (N = 158) with posterior deep intramural, intraligamental, or cervical leiomyomas; 81 patients underwent USAS (suspension group), and 77 patients did not (control group) concomitantly with laparoscopic myomectomy. InterventionsTransabdominal USAS was performed for all eligible patients undergoing laparoscopic myomectomy using a 2-0 synthetic, monofilament, nonabsorbable polypropylene suture. One end of the double-headed straight needles of the polypropylene suture was inserted into the pelvic cavity through the abdomen to “lift” or “retract” the uterus to allow for the main tumor to be completely exposed and excised. Measurements and Main ResultsThe average time to create USAS was 2.5 minutes. For the suspension and control groups, the average number of abdominal ports was 3 and 4.4 (p < .001), the average blood loss was 96.3 and 201.5 mL (p < .001), and the average operative time was 50.8 and 91.2 minutes (p < .001), respectively. There was no significant difference in complications (4.9% vs 9.1%, p = .303), but there was a significant difference in conversion to laparotomy (1.2% vs 10.4%, p = .009). At the 3-year follow-up, there were no significant differences in gynecologic and reproductive outcomes, including leiomyoma recurrence, uterine rupture, and pregnancy and live birth rates. The ratio of conversion to laparotomy (odds ratio = 0.108; 95% confidence interval, 0.013–0.884) was much lower in the suspension group. ConclusionUSAS is an easy, safe, and feasible alternative to uterine manipulation when performed concomitantly with laparoscopic myomectomy for unfavorably localized uterine leiomyomas.

Pronostic obstétrical des patientes présentant un antécédent de césarienne réalisée avant 32 semaines d’aménorrhée

ObjectiveTo assess delivery mode, maternal morbidity including uterine rupture and scar dehiscence and neonatal outcome, during a pregnancy after a previous caesarean delivery before 32 weeks of amenorrhea. MethodsA retrospective descriptive study was carried out at the Besançon University Hospital during an 8-year period. We identified 292 consecutive patients presenting a singleton pregnancy delivery before 32 weeks of amenorrhea. We analysed the next pregnancy. Patients presenting more than one caesarean section were excluded from this study. ResultsOut of the 292 patients, 62 met inclusion criteria. The average gestational age of the first caesarean section was 29 weeks and 3 days. Among these patients, 17 (27.4%) had a planned caesarean delivery after caesarean (CDAC) and 45 (72.6%) had a trial of vaginal delivery (TVD) with a success rate of 71.1%, that is a total of 51.6% of vaginal delivery after a previous early caesarean section. In case of a failed TVD, arterial pH (P<0.005), Apgar score at one minute (P<0.05) and at 10minutes (P<0.05) were significantly lower compared to the CDAC group. Regarding perinatal outcome, there was no significant difference (P=0.31) between the groups in intention to treat. The only uterine rupture (1.6%) was noticed during a caesarean section at 26 weeks and 3 days, in a patient initially included in the TVD group. Five uterine scar-dehiscences (8.1%) were discovered including 80% during caesarean section, at an average term of 32 weeks and 2 days of amenorrhea. ConclusionAfter an early caesarean section, trial of vaginal delivery can be implemented if local conditions are favorable. There is no difference in maternal morbidity, success of labour and neonatal outcome if previous caesarean section was performed before 32 weeks or at term. It appears however that uterine rupture rate (complete or incomplete) is slightly higher in comparison to a previous caesarean at term, which might occur prematurely and before labour.

Simplified and standardized intrapartum management can yield high rates of successful VBAC in spontaneous labor

Objective: To examine the outcomes of vaginal birth after cesarean (VBAC) in women, in spontaneous labor, delivering after 37 weeks’ gestation at an institution where trial of labor after a previous cesarean delivery (TOLAC) is encouraged and management of labor is standardized.Methods: This retrospective cohort study included 3071 women with one previous cesarean only and no vaginal delivery who underwent a trial of labor from 2001 to 2011. Women were managed using the standardized “active management of labor” intrapartum protocol. Outcomes and characteristics of women who delivered vaginally were compared with those who required cesarean delivery.Results: In spontaneous labor in their second pregnancy, those who attempted TOLAC had a 72.5% (1611/2222) rate of successful VBAC. Women who had a successful VBAC had smaller babies (3584 ± 452 g versus 3799 ± 489 g; p < 0.0001) at earlier gestations than those who had a repeat intrapartum cesarean delivery. They also required less intrapartum intervention, such as oxytocin augmentation (14.5% [234/1611] versus 41% [251/611]; p < 0.0001) and epidural anesthesia (64.8% [1044/1611] versus 82.8% [506/611]; p < 0.0001). The rate of uterine rupture was 0.54% (12/2222), while the rate of peri-partum hysterectomy was 0.18% (4/2222).Conclusion: This study shows that serious complications associated with TOLAC are rare providing intrapartum care and decision-making is made simple for the benefit of staff and patients alike. This is achieved through a standardized labor management protocol.

Balloon catheters for induction of labor at term after previous cesarean section: a systematic review

To systematically review the application of balloon catheters for cervical ripening and labor induction at term after previous cesarean section.All pregnancies at term with previous cesarean section were included when cervical ripening or labor induction was conducted with balloon catheters. MEDLINE, Cochrane database and bibliography of identified articles were searched for English language studies. Reviews and meta-analysis, randomized and non-randomized controlled trials, prospective and retrospective cohort studies as well as case-control studies were considered.A total of 48 potentially relevant studies were identified. The title and abstract were screened for eligibility and 32 articles were excluded. The remaining 16 publications included 1447 women (single-balloon catheter: n=1329, double-balloon catheter: n=118). There were no randomized controlled trials. Most of the trials were retrospective studies (n=10). The rate of uterine rupture after labor induction was low (n=18, 1.2%). Meta-analysis of studies comparing the risk of uterine rupture between labor induction and spontaneous onset of labor found a higher risk after induction (OR 2.45, 95%CI 1.34–4.47, NNH 186). The average rate of oxytocin application was 68.4%, and vaginal birth was achieved in 56.4%. The risk for cesarean delivery was higher when labor was induced (OR 2.63, 95%CI 2.24–3.10).Data on balloon catheters for labor induction after previous cesarean section are limited by small sample size and retrospective analyses. The present data show a moderately increased risk for uterine rupture (OR=2.45) compared to spontaneous onset of labor. However, for evidence based recommendations much more well-conducted trials are needed.

Cornual wedge resection for interstitial pregnancy and postoperative outcome.

Traditionally, interstitial pregnancies were treated with cornual resection or hysterectomy via laparotomy. However, increasingly, interstitial pregnancies are treated with laparoscopic cornuotomy, ie, removal of ectopic pregnancy tissue with preservation of uterine architecture. Although this technique may increase the incidence of persistent and recurrent interstitial pregnancy, it can potentially maintain patient fertility and decrease their risk forfuture uterine rupture. In a case series of patients with interstitial pregnancies treated with cornual wedge resection, we examined fertility outcomes, rates of subsequent uterine rupture, and rates of persistent or recurrent interstitial pregnancy. We conducted a retrospective medical record review of cases (n=29) of cornual wedge resection for interstitial pregnancy, performed between 1992 and 2013 at one hospital. Of the 29 cases, two later presented with uterine rupture; one, who also had a prior wedge resection, was found with scar dehiscence during a subsequent caesarean section. The incidence of subsequent uterine rupture and dehiscence was 30%. There were no cases of persistent ectopic pregnancy or recurrent interstitial pregnancy. Most (71.4%) patients who were trying to conceive achieved subsequent pregnancy. There is debate regarding the recommended surgical technique to treat interstitial pregnancies; cornual resection and cornuotomy are both important considerations. Choice of the technique employed continues to require careful consideration.

The Nordic Obstetric Surveillance Study: A Study of Complete Uterine Rupture, Abnormally Invasive Placenta, Peripartum Hysterectomy, and Severe Blood Loss at Delivery

(Acta Obstet Gynecol Scand. 2015;94:734–744) There is a lack of reliable research regarding severe complications at delivery, which is most likely due to the rarity of such complications. There is also the issue of interactions between different severe complications, questionable reporting, and the absence of precise terminology. The Nordic Obstetric Surveillance Study (NOSS) evaluated the rate of uterine rupture, placenta accreta, peripartum hysterectomy, and severe blood loss during delivery in Nordic countries as well as the characteristics of the women who suffered these complications. The aim was to provide valuable information that might help guide the management of obstetric emergencies.

Medical management of unruptured interstitial pregnancy with mifepristone and methotrexate

Ectopic pregnancy is a serious complication of pregnancy in which embryo gets implanted any where other than the uterine cavity. In interstitial pregnancy, the pregnancy is located in that part of the fallopian tube that penetrates the muscular layer of the uterus. Overall incidence of ectopic pregnancy is one to two percent among which the incidence of interstitial pregnancy is only two percent. Interstitial pregnancy being the hazardous type requires immediate management. Though surgical treatment is the management of choice, its association with decreased fertility rate and increased rate of uterine rupture in future pregnancy cannot be ignored. We hereby report of medical management of interstitial ectopic pregnancy with single oral dose of Mifepristone 200mg along with single dose of Methotrexate 50miligram intramuscularly.Journal of Kathmandu Medical College, Vol. 4(1) 2015, 34-36

Maternal and Perinatal Outcomes of Uterine Rupture Patients among Mothers who Delivered at Mizan Aman General Hospital, SNNPR, South West Ethiopia; A Five Year Retrospective Hospital Based Study

Background: Uterine rupture causes high maternal and perinatal mortality in many rural setting in the world. Ethiopia is one of the less developed countries where maternal and perinatal mortality rates are still very high. Objective: To determine maternal and perinatal outcomes of uterine rupture patients among mothers who delivered at Mizan-Aman General Hospital, South west Ethiopia. Methods: A descriptive hospital based cross sectional study on maternal and perinatal outcome of uterine rupture patients among mothers who delivered at Mizan-Aman General Hospital was done from June 1, 2011 - May 31, 2015. Data on socio demographic, obstetrics, intraoperative, post op complication, maternal and perinatal outcome was collected. The collected data analyzed with SPSS 20.0. Association between dependent and independent variables was done by using binary logistic regression model and P-Value <0.05 at 95% CI was taken as statistically significant. Result: 115 patient cards were included in the study. There were 1(8.3%) intra operative maternal death and 11(91.7 %) post-operative death, making case fatality rate of uterine rupture 10.4 %. The incidence of uterine rupture in the hospital was 1.6%. There were 110(95.6%) of neonatal death and 5(4.6%) of neonate were delivered alive, those delivered with instrument and from previous uterine scar. The common causes of uterine rupture were obstructed labor 57(49.6%) followed by malpresentation and malposition which account 26(22.6%). Of all uterine rupture patients 102(88.7%) were complete rupture, the common site of rupture were 38(33%) anterior transverse lower segment followed by anterior low vertical 22(19.1%). Repair with bilateral tubal ligation in 48(41.7%) followed by repair without bilateral tubal ligation in 34(29.6%) were the common procedures done for ruptured uterus patients. Conclusion:Hemoglobin level, blood transfusion, diagnosis of uterine rupture before operation had strong association with maternal out come and neonatal intensive care unit admission had also strong association with perinatal outcome. The common causes of uterine rupture are obstructed labor followed by malpresentation/ position. Complete uterine rupture and anterior lower segment rupture were by far the commonest patterns of uterine rupture by type and site respectively.

Minimally Invasive Surgical Techniques vs Open Myomectomy for Treatment of Uterine Fibroids

Introduction: Myomectomy is the surgical remedy of preference for women with symptomatic fibroids, who prefer or want uterine conservation. Myomectomy can be finished by using conventional laparotomy, by means of minilaparotomy, or by means of minimal access techniques, such as hysteroscopy and laparoscopy. Since the advent of minimal access surgery, there has been interest in the relative advantages and disadvantages of both surgical modalities. Objectives: To determine the benefits and harms of laparo scopic myomectomy compared with open myomectomy. Materials and methods: We used various search engines – PubMed, HighWire Press, Google, and Yahoo – to search for all trials and articles comparing myomectomy via laparotomy, minilaparotomy, or laparoscopically assisted minilaparotomy vs laparoscopy. We found several articles of which 10 were used in this review article based on the outcomes studied, date of publication (after 2005), methodology of study, level of evidence, and the journal in which they were published. The results of these trials were then compared. Conclusion: Laparoscopic myomectomy is a process associated with less subjectively reported postoperative pain, lower postoperative fever, and shorter hospital stay as opposed to all kinds of open myomectomy. No data suggested a difference in recurrence risk between laparoscopic and open myomectomy. Even more studies are needed to determine fertility outcomes, rates of uterine rupture, occurrence of thromboembolism, and need for repeat myomectomy and hysterectomy at a later stage.

Rupture of Unscarred Uterus: A Rare Cause of Abdominal Pain in Pregnancy

Copyright: © 2015 Abdalla N, et al. This is an open‐access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Uterine rupture is rare during pregnancy and its associated with high maternal and fetal mortality [1]. The incidence rate of uterine rupture is 5,3 per 10000 deliveries among unselected pregnant women [2]. The most common risk factor of uterine rupture is previous caesarean section and uterine surgery [3]. Other risk factors include multiparity, a short length of time (less than 18 months) since the last caesarean section, the number of previous caesarean sections, single-layer closure instead of two-layer closure, placenta previa, fetal malpresentation, macrosomia, forced amnio-infusion, multiple gestation, cephalopelvic disproportion and the use of prostaglandins or oxytocin for labor induction [4,5]. In more than half of cases of ruptured unscarred uterus no evident risk factor can be found [1]. Rupture of unscarred uterus is very rare, involving 1: 17,000–20,000 deliveries, however it’s associated with high rate of maternal and perinatal morbidity and mortality [6,3]. The rupture could be traumatic or spontaneous [6]. The distribution of causes of uterine rupture varies from one country to another. In developed countries most uterine ruptures are associated with scarred uterus or trauma. In developing countries rupture occur mainly spontaneously in an unscarred uterus [7]. This may be related to multiparity in developing countries that causes weakening of the uterine wall. In the study of Schrinsky et al. 32% of women who had unscarred uterine rupture had a parity of greater than four [8].

Risque de rupture utérine après maturation des utérus cicatriciels par sonde à ballonnet

To evaluate the rate of uterine rupture after cervical ripening by mechanical methods using balloon catheter in patients with a previous cesarean section. A literature search using the Medline database, Cochrane Library(®) database. We identified 13 studies evaluating four types of ballon catheter. One thousand two hundred and seventy-eight patients underwent cervical ripening by balloon catheter and 8 (0.62%) cases of uterine rupture were reported. The vaginal delivery rate was 741/1278 (58%). The use of balloon catheters in case of previous cesarean section does not appear to be associated with an increased risk of uterine rupture compared with spontaneous labor. However, further studies are required to evaluate correctly this risk.