Risk Factors For Uterine Rupture Research Articles

An Audit of Stroke at Muhammad Medical College.

Objective:1. To determine the number of stroke patients admitted at Muhammad Medical College, Mirpurkhas.2. To see the facilities available for management of stroke and make recommendationsStudy Design: Retrospective review of case notes.Place & Duration of Study: Patients admitted with diagnosis of stroke at Muhammad Medical College,Mirpurkhas with effect from 01-01-2010 to 31-12-2010Methodology: Retrospective audit of file notes of all patients admit in 2010 with stroke. This study was approved by the Hospital Research & Ethics Committee (No. 240811/REC/001)Results: 39 patients (24 males and 15 females) were admitted with diagnosis of stroke during this period. Theaverage age was 57 years (14-90). CT scan showed infarction in 27 (69%) and hemorrhage in 12 (31%). 10 patients (25.6%) died during admission.Conclusions: Rupture of gravid uterus is a life threatening emergency requiring immediate surgical interventionwith more than 95% feotal deaths and Injudicious use of oxytocin by Dais/ TBAS was the most common cause ofruptured uterus.High parity, illiteracy, ignorance coupled with inadequate maternity service, lack of antepartum and intraprtumcare, prior caesarean delivery were identified as risk factors for uterine rupture, its occurrence is usuallyassociated with considerable maternal and fetal mortality and morbidity.Keywords: Stroke, Cerebrovascular accident, infarction, hemorrhage.

Trial of labor and gynecological uterine scars : anarrative review

The increasing number of women of childbearing age with gynecological uterine scars presents a significant clinical challenge. -Planning the route of birth for a subsequent pregnancy necessitates -careful consideration and should be the subject of an informed -discussion. Unfortunately, the heterogeneity of data in the literature with regards to gynecological uterine scars makes this choice -debatable. Although the use of less invasive surgical procedures in this context is on the rise, there is currently a lack of robust data on their obstetric repercussions. This article -explores risk factors for uterine rupture in the view of gynecological uterine scars and -provides pragmatic recommendations for clinicians.

1139 Risk factors of uterine rupture in individuals attempting TOLAC in the setting of stillbirth

1139 Risk factors of uterine rupture in individuals attempting TOLAC in the setting of stillbirth

Risk of uterine rupture in multiparous women after induction of labor with prostaglandin: A national population-based cohort study.

To assess whether, after induction of labor with prostaglandin, multiparous (≥2 para) women have an increased risk of uterine rupture compared with nulliparous or uniparous women. This was a retrospective population-based cohort study including women who underwent induction with prostaglandin in all maternity wards in Sweden between May 1996 and December 2019 (n = 56 784). The study cohort was obtained by using data from the Swedish Medical Birth Register, which contains information from maternity and delivery records. The main outcome measure was uterine rupture. Overall, multiparous women induced with prostaglandin had an increased risk of uterine rupture compared with nulliparous women (adjusted odds ratio [OR], 3.33 [95% confidence interval (CI), 1.38-8.04]; P < 0.007). Multiparous women with no previous cesarean section (CS) induced with prostaglandin had more than three times higher risk of uterine rupture (crude OR, 3.55 [95% Cl, 1.48-8.53]; P = 0.005) compared with nulliparous women and four times higher risk compared with uniparous women (OR, 4.10 [95% CI, 1.12-15.00]; P < 0.033). Multiparous women with previous CS had a decreased risk of uterine rupture compared with uniparous women with one previous CS (crude OR, 0.41 [95% Cl, 0.21-0.78]; P = 0.007). Our study implies that multiparity in women with no previous CS is a risk factor for uterine rupture when induced with prostaglandin. This should be taken into consideration when deciding on the appropriate method of induction.

Placenta percreta in primigravida with unscarred uterus complicated by uterine rupture and sudden maternal and fetal death: an autopsy case report.

Placenta percreta is a rare, aggressive, and severe form of the placenta accreta spectrum. One of its most devastating effects is the sudden rupture of uterus. Uterine scarring is the leading risk factor for uterine rupture, although it can also happen, but rarely, in an unscarred uterus showing more severe repercussions. The present study reported a case of an Egyptian primigravida female, aged 29 years old, at 32 weeks of gestation who died suddenly due to uterine rupture complicating placenta percreta, the diagnosis of which was first settled during autopsy. There was no history of abdominal trauma. No medical history of significance was present. Autopsy denoted an intrauterine fetal death of 32 weeks gestational age. The fundus of the uterus had a laceration (rupture) of the uterine wall including the serosa and myometrium. The placenta has extensively infiltrated the fundus uterine wall and penetrated the myometrium and serosa. Histopathological examination of the ruptured site on the uterus confirms total invasion of the uterine wall by chorionic villi with the presence of hemorrhage and fibrin indicating placenta percreta. Uterine rupture due to placenta percreta may go unnoticed, especially when no associated high-risk factors exist. The current case depicts that placenta percreta is a rare but critical complication of pregnancy that may exist at any stage of pregnancy without any associated high-risk factors with unusual symptoms and leads to uterine rupture and sudden death.

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.

Posterior Uterine Wall Rupture in a Multiparous Female Presenting Post-Cesarean Deliveries: A Case Report.

Uterine rupture is a rare and one of the most dreaded complications of pregnancy. It carries potentially disastrous consequences for both the mother and the fetus. It occurs frequently during the antepartum or peripartum period. In the majority of cases, the rupture occurs at the lower anterior uterine segment. However, the rupture can rarely occur atypically at the posterior wall and away from the surgical scar. The recognized major risk factors for uterine rupture include previous cesarean deliveries, uterine surgeries, advanced maternal age, and induction of labor with prostaglandins. Our center experienced an unusual case of posterior uterine rupture in a 40-year-old gravid woman, G8P6A1, presenting four hours after cesarean delivery with non-specific clinical presentation of hypotension and paleness. Physical examination revealed no abdominal distension, pain, or tenderness. Blood per-vaginum was not remarkable. The diagnosis was initially made by ultrasonographic findings and was confirmed by exploratory laparotomy. A subtotal hysterectomy was performed. Our case represents an atypical case of uterine rupture with regard to the time of presentation and the clinical features. A high-index of suspicion is therefore necessary for prompt diagnosis and management to prevent non-desirable outcomes.

New ultrasonographic risk assessment of uterine scar dehiscence in pregnancy after cesarean section

PurposeWe performed a new ultrasonographic risk assessment of uterine scar dehiscence, which is a potential risk factor for uterine rupture, in pregnancy after cesarean section. We attempted to shed light on the natural course of the change in the lower uterine segment by means of a longitudinal investigation through quantitative and qualitative evaluations.MethodsThis retrospective single-center study involved 31 women with a normal singleton pregnancy delivered by elective cesarean section between 2020 and 2021, with all women showing a “niche” in the lower uterine segments. The lower uterine segments were assessed qualitatively and quantitatively using transvaginal ultrasonography at 16–21, 22–27, and 28–33 weeks of gestation, and subjects were divided into two groups: those with uterine dehiscence (12 women) and those without uterine dehiscence (19 women), depending on the gross findings of the lower uterine segments at cesarean section. Analyses were performed using Wilcoxon’s rank-sum and Mann–Whitney U test with a significance level of P < 0.05.ResultsThe lower uterine segments changed from V-shaped to U-shaped to thin as gestation progressed and was more prominent in the uterine dehiscence group, occurring mostly at 22–27 weeks. At 22–27 weeks, the median myometrial thickness in the uterine dehiscence group was lower than in the group without uterine dehiscence (P = 0.0030). Thinning of the lower uterine segments had moved the cephalad at 22–27 and 28–33 weeks in cases with and without uterine dehiscence.ConclusionA model of morphological changes in the niche was constructed based on qualitative and quantitative assessments. The morphological changes and actual thinning of the lower uterine segments were prominent in the second trimester in women considered to have uterine scar dehiscence.

A case of uterine rupture in second term delivery after septum resection

Introduction: The decision to resect a uterine septum remains individualized. Hysteroscopic approach is the gold standard for uterine septum resection. Uterine rupture in subsequent pregnancy is a known but rare complication without identified methods of prevention. Case Report: A 32-year-old woman underwent uncomplicated hysteroscopic uterine septum resection followed by uncomplicated term vaginal delivery, with uterine rupture and intrauterine fetal demise at 38 weeks gestational age in the subsequent pregnancy. Conclusion: Term uterine rupture is possible when the only history of uterine surgery is hysteroscopic septum resection, even with an intervening delivery. Providers should have a low threshold to initiate diagnostic evaluation with fetal or maternal distress in pregnancy after any uterine surgery. Modifiable risk factors for uterine rupture after septum resection may include residual septa, short interval between surgery and pregnancy, and labor induction methodology. Providers should consider these factors when counseling regarding the risks and benefits of resection.

Uterine rupture in labor following perforation during operative hysteroscopy-a case report and review of literature

Background: Hysteroscopic surgeries have become the standard treatment for uterine septa, synechiae, submucous myomas and endometrial polyps. It is considered a safe procedure: the incidence of surgical complications, including uterine perforation, is low (0.95% - 2.7%). Uterine rupture secondary to operative hysteroscopy is rare but potentially catastrophic. It can occur both before the onset of labor or during labor, severely compromising fetal and maternal outcomes. An operative hysteroscopy for retained placenta done one month after a normal vaginal delivery was complicated by a fundal uterine perforation whilst the removal of the abnormal tissue. The perforation was assessed laparoscopically and minimal bleeding was electrocoagulated. The patient was counseled that this complication should not affect future deliveries. In her subsequent pregnancy, an emergency cesarean hysterectomy was performed during advanced labor due to cornua-to-cornua fundal uterine rupture. Conclusion: There are many potential risk factors for uterine rupture in pregnancy. While previous cesarean delivery is the most well-known, prior complex hysteroscopy appears to also be a risk factor. While the exact relative risk is still unclear we feel that patients undergoing hysteroscopy for uterine septum and cases complicated by fundal uterine perforation during hysteroscopy must be informed about the risk of future uterine rupture, both during labor and during pregnancy. Out: We then summarize previous literature regarding hysteroscopy and uterine rupture focusing on risk factors such as surgery for uterine septum, use of electrocautery and uterine perforation. The Time interval between hysteroscopy and pregnancy does not appear to be a risk factor. Precis: Operative hysteroscopy complicated by fundal uterine perforation is a risk factor for uterine rupture both during pregnancy and labor.

Time Matters: A Swedish Cohort Study of Labor Duration and Risk of Uterine Rupture

(Acta Obstet Gynecol Scand. 2021;100:1902–1909) In medium- to high-resource settings, a previous cesarean delivery (CD) is the main risk factor for uterine rupture, which is associated with maternal and neonatal morbidity and mortality. Induction of labor and augmentation of labor with oxytocin are both modifiable risk factors but are also common in patients who do not experience uterine rupture. One risk factor that could potentially help identify patients at risk of uterine rupture is slower progression in labor. This study aimed to examine the relationship between duration of labor and uterine rupture in the first trial of labor after one CD. The study also aimed to evaluate risk factors such as induction and use of prostaglandins, oxytocin, and epidural analgesia.

Complete Uterine Rupture: A Case Report

Abstract Background: Uterine rupture during pregnancy is a considerable obstetric complication. The presence of a previous uterine scar is the most significant risk factor. Early clinical diagnosis is paramount to maternal and fetal survival. Case Report: A 36- year-old woman, gravida 2 para 2, presented with sudden acute abdominal pain at 38 weeks of gestation. The patient had a history of cesarean delivery one year ago. Ultrasound scans showed an empty endometrial cavity and fetus outside the uterus. Emergency laparotomy was performed, a live baby boy weighing 3.420 kg was delivered, and the uterine disruption was repaired. Conclusion: Increasing trends in the cesarean section may lead to a higher number of uterine ruptures. The survival of patients after uterine rupture depends on the time interval between rupture and intervention, and the availability of appropriate medical team and equipment. Health professionals caring for pregnant women should be alert for the symptoms and risk factors of uterine rupture.

An Unexpected Cause of Recurrent Fetal Decelerations

An Unexpected Cause of Recurrent Fetal Decelerations

Uterine rupture risk in a trial of labor after cesarean section with and without previous vaginal births.

Previous cesarean delivery (CD) is the main risk factor for uterine rupture when attempting a trial of labor. Previous vaginal delivery (PVD) is a predictor for the trial of labor after cesarean (TOLAC) success and a protective factor against uterine rupture. We aimed to assess the magnitude of PVD as a protective factor from uterine rupture. A retrospective cohort study was conducted, including women who underwent TOLACs from 2003 to 2015. Women with and without PVD were compared. Inclusion criteria were one previous CD, trial of labor at ≥ 24weeks' gestation, and cephalic presentation. We excluded pre-labor intrauterine fetal death and fetal anomalies. The primary outcome was a uterine rupture. Secondary outcomes were maternal and fetal complications. Logistic regression modeling was applied to analyze the association between PVD and uterine rupture while controlling for confounders. A total of 11,235 women were included, 6795 of which had a PVD. Women with PVD had significantly lower rates of uterine rupture (0.18% vs. 1.1%; OR 0.19, p < 0.001), were less likely to be delivered by an emergency CD (13.2% vs. 39.4%, OR 0.17, p < 0.0001), were more likely to undergo labor induction (OR 1.56, p < 0.0001), and were less likely to undergo an instrumental delivery (OR 0.14, p < 0.001). Logistic regression modeling revealed that PVD was the only independent protective factor, with an aOR of 0.22. PVD is the most important protective factor from uterine rupture in patients undergoing TOLAC. A trial of labor following one CD should therefore be encouraged in these patients.

Successful Management of a Noncommunicating Rudimentary Uterine Horn Pregnancy by Laparoscopic Surgery: A Case Report and Literature Review.

Pregnancy in a noncommunicating rudimentary horn is extremely rare but can cause serious clinical complications, such as uterine rupture. The standard treatment is excision of the rudimentary horn, and recently, in some cases, laparoscopic resection has been performed in the first trimester of gestation. Herein, we present a case of noncommunicating rudimentary horn pregnancy (NCRHP), which was diagnosed by magnetic resonance imaging at 6 weeks of gestation and treated by laparoscopic surgery. However, we have also found some rare cases in which patients could obtain live newborn babies. Since management is affected by the different levels of obstetric medical care and diagnostic tools, we also performed a review and analysis of NCRHP. A PubMed search yielded 103 cases reported in the English literature. Correct diagnosis and laparoscopic treatment were achieved more frequently in developed countries, especially in the first trimester of gestation. On the other hand, symptoms, including abdominal pain and hypovolemic shock, tended to occur in the second trimester of gestation. This period was also found to be a risk factor for uterine rupture. Among 18 patients at the third trimester of gestation, 13 obtained live neonatal infants. Therefore, detailed information about this disease is crucial for proper treatments.

How does uterine contractile activity affect the success of trial of labour after caesarean section, and the risk of uterine rupture? An exploratory, blinded analysis of a cohort from a randomised controlled trial.

ObjectiveTo investigate the impact of uterine contractile activity on the outcome of trial of labour after caesarean section (TOLAC).DesignSecondary, blinded analyses of a prospective TOLAC cohort.SettingTwo labour wards, one in a university tertiary hospital and the other in a central hospital.PopulationA total of 194 TOLAC parturients with intrauterine tocodynamometry during labour.MethodsAnalysis of intrauterine pressure, frequency of contractions and baseline tonus of uterine muscle in 30‐minute periods for 4 hours before birth.Main outcome measuresPrimary outcome: uterine contractile activity during TOLAC. Secondary aims: contributors associated with failed TOLAC and uterine rupture.ResultsTOLAC succeeded in 74% of cases. Uterine contractile activity, expressed as intrauterine pressure, was significantly higher in successful TOLAC compared with failed TOLAC (210 versus 170 Montevideo units). The statistically significant risk factors of failed TOLAC, after multivariate regression analysis, were prolonged gestational age, reduced cervical dilatation at admission and lower mean intrauterine pressure. In cases of uterine rupture, contractile activity did not differ from that in failed TOLAC. Cervical ripening with a Foley catheter appeared to be a risk factor for uterine rupture, as well as cervical dilatation <3 cm at admission. The incidence of total uterine rupture was 2.6% (n = 5).ConclusionsWomen with successful vaginal birth had higher uterine contractile activity than those experiencing failed TOLAC or uterine rupture despite similar use of oxytocin. Induction of labour with a Foley catheter turned out to be a risk factor for uterine rupture during TOLAC among parturients with no previous vaginal delivery.Tweetable abstractDuring VBAC the response to oxytocin, assessed as intrauterine pressure, is greater and adequate, in contrast to failed TOLAC.

Intramural Ectopic Pregnancy: Clinical Characteristics, Risk Factors for Uterine Rupture and Hysterectomy.

Background: Intramural ectopic pregnancy is defined as the gestational sac (GS) is entirely within the myometrium, separate from the endometrial cavity and fallopian tubes, which is unsustainable and potentially life-threatening. The data investigating the clinical characteristics, management strategy, and fertility outcomes after treatment of intramural ectopic pregnancies are very limited due to its extreme rarity.Methods: To investigate the clinical characteristics, treatment options, and fertility outcomes in patients with intramural ectopic pregnancy, a retrospective study included 56 patients was conducted. We also used logistic regression to identify potential risk factors for uterine rupture and hysterectomy in these patients.Results: The mean age of patients was 31.1 years, with an average gestational age (GA) of 10.0 weeks, and the majority of the patient cohort (83.9%) had uterine or endometrial surgical history. 55.4% of the intramural pregnancy was diagnosed by preoperative imaging examination and 67.7% was detected by ultrasound. There was no dominant predisposed zone of the GS. Common treatment strategies included laparotomy surgery (41.1%) and laparoscopic surgery (35.7%), followed by methotrexate (7.1%) and expectant management (5.4%). Uterine rupture occurred in 9 patients and 8 patients underwent a hysterectomy, but no maternal demise was found. Logistic regression showed that a GA >10 weeks predicted a significantly higher risk of uterine rupture (Odds ratio [OR] 8.000, 95% confidence interval [CI] 1.456–43.966, P = 0.017) and hysterectomy (OR 12.333, 95% CI 2.125–71.565, P = 0.005), and GS located in the fundus also predicted higher probability of uterine rupture (OR 7.000,95% CI 1.271–38.543, P = 0.025). Among the ten patients who had a desire for fertility, 6 of them succeeded and 4 of them successfully delivered with a GA ≥ 34 weeks.Conclusion: GA > 10 weeks was the risk factor for both uterine rupture and hysterectomy, while patients with GS located in the uterine fundus had a significantly higher risk of uterine rupture. The fertility outcomes were moderate after treatment. The management strategies should be individualized according to disease conditions and the desire for fertility, and early diagnosis is essential for optimizing clinical outcomes.

English

BACKGROUND Uterine rupture is defined as the tearing of the muscular wall of the uterus during pregnancy or labour.1 Often it occurs from the tearing of previous caesarean scar during labour.2 The other known risk factors for uterine rupture include, maternal age, height, body mass index (BMI), education, birth weight, gestational age, induction of labour, instrumental vaginal delivery, interpregnancy interval, congenital uterine anomaly, grand multiparity, previous uterine surgery, fetal macrosomia, fetal malposition, obstructed labour, uterine instrumentation, attempted forceps delivery, external version, and uterine trauma. 2-6This study was done to find out the prevailing risk factors associated with this grave condition in Bundelkhand region, so that mortality and morbidity associated with it could be prevented. METHODS We have studied 37 cases of uterine rupture, operated in our institution from Jan. 2018 to Oct. 2019. During this period a total of 2986 Caesarean sections (CS) were performed. Of these 37 cases, 5 were Nullipara (13.51 %), 16 primipara (31.25 %) and 16 were grand multipara (31.25 %). 24 cases (64.86 %) had previous uterine scar while 13 (35.13 %) had no scar. RESULTS In our study major risk factors for uterine rupture were found to be previous scars (64.68 %). Obstructive labour (23.07 %), malpresentation (7.69 %), grand multiparity (38.46 %) and prolong labour (30.76 %), were responsible for rupture in unscarred uterus. In all cases we first tried to repair the tear and only 9 (24.32 %) needed hysterectomy. In our study 28 patients (75.67 %) required only repair whereas 24.32 % cases needed hysterectomy. Maternal death was just 1 case (2.7 %) and (51.35 %) babies survived. CONCLUSIONS Majority of uterine rupture cases were found in women who had previous CS. So, first CS should be performed after very careful understanding of its indications. 2.7 % maternal mortality and 51.35 % delivery of live birth babies in our study proves that early detection and proper managing of the case can reduce maternal and fetal mortality in uterine rupture cases. KEY WORDS Uterine Rupture, Previous Scar, Inter-Pregnancy Interval

Ultrasonic diagnosis of asymptomatic rupture of uterine in second trimester of pregnancy after laparoscopic surgery for interstitial pregnancy: a case report

BackgroundUterine rupture is a rare, life-threatening event in obstetrics that may be fatal for the mother and fetus. Therefore, obstetricians need to pay attention to and should consider the antenatal diagnosis of uterine rupture in women having its risk factors. Successful conservative management for asymptomatic uterine rupture due to previous laparoscopic surgery for interstitial pregnancy has already been reported but remains understudied.Case presentationA 39-year-old woman was diagnosed asymptomatic uterine rupture at 22 weeks gestation by a routine second-trimester ultrasound scan. She had a history of laparoscopic salpingectomy with cornual wedge resection for interstitial pregnancy 10 months before this pregnancy. Refusing doctor’s twice advice of terminating the pregnancy, the patient insisted carrying on the pregnancy, and followed up by ultrasound and magnetic resonance imaging. Fetal growth was appropriate, fetal movements were good and the patient had no symptoms, without uterine contraction or amniotic fluid loss throughout follow-up period. Caesarean section was carried out at 34 + 1 weeks with a good maternal and neonatal outcome.ConclusionsA previous history of laparoscopic salpingectomy with cornual wedge resection could be a risk factor for uterine rupture in pregnant women. Sonographers should be alert to this potential risk in pregnant women with a history of laparoscopic salpingectomy with cornual wedge resection even in asymptomatic patients.

UTERINE RUPTURE DURING PREGNANCY – CASE REPORT

Uterine rupture is a life-threatening complication in pregnancy with no specific signs and symptoms, that requires fast diagnosis and surgical treatment. The main risk factors for uterine rupture are previous caesarean section deliveries and myomectomies, which can lead to improper uterine wall healing. We report a case of a 37-year-old secundigravida in 29 weeks of pregnancy, with prior caesarian delivery that was admitted in our ward for altered general status and abdominal pain. The patient underwent emergency laparotomy during which we found a massive 3500ml hemoperitoneum, 1000 g dead fetus and a rupture in the posterolateral uterine wall. The uterine scar from the previous caesarian section was intact. Uterine rupture is a complication with a growing incidence in past years that is very difficult to predict, which can occur at any time during pregnancy, especially during labour, but also in the second or early third trimester. Fast diagnosis and proper management is imperious because of the catastrophic outcomes uterine rupture is associated with.