Rupture In Women Research Articles

Aortic Size Index Versus Aortic Diameter in the Prediction of Rupture in Women With Abdominal Aortic Aneurysm

Aortic Size Index Versus Aortic Diameter in the Prediction of Rupture in Women With Abdominal Aortic Aneurysm

Efektivitas Air Rebusan Daun Binahong Dengan Air Rebusan Daun Sirih Terhadap Penyembuhan Ruptur Perineum Pada Ibu Bersalin Di Puskesmas

Introduction: Perineal rupture is a birth canal tear that often occurs in the normal delivery process and is a health problem that must be treated immediately because it can cause infection so treatment needs to be carried out. The data from the Banjarsari Health Center report in 2021 showed that there were 35 cases of perineal rupture (72,91%) from 48 postpartum mothers. The purpose of the research is to find out the effectiveness of boiled water from binahong leaves with boiled water from betel leaves for healing perineal rupture in women giving birth at the Banjarsari Health Center Lebak Regency in 2022. Methods: The research method uses quasi-experiments with a posttest-only design with non-equivalent groups. The sample of this study was a spontaneous postpartum mother who experienced a perineal rupture of 30 people with a sampling technique using simple random sampling. Instruments use questionnaires. The Bivariate analysis uses the paired t-test and independent t-test. Results: The average healing time of perineal rupture given boiled water of binahong leaves is 5,87 (5 to 6 days) while that given boiled water of betel leaves is 7,93 (7 to 9 days). The results of statistical tests show that there is the effectiveness of binahong leaf boiled water with betel leaf boiled water against healing perineal rupture in maternity mothers at the Banjarsari Health Center Lebak Regency in 2022 (p = 0,006). Discussion: Giving boiled water to binahong leaves is faster and more effective in curing perineal rupture compared to giving betel leaf boiled water. It is hoped that postpartum mothers can use non-pharmacological methods using herbal complementary therapy for the treatment of perineal rupture namely by using binahong leaf boiled water or using betel leaf boiled water.

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.

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.

The Relationship 0f Prenatal Yoga with Perineum Rupture

Prenatal yoga trains the perineal muscles to be stronger and stretches elastically during the delivery process so that it is effective in preventing perineal rupture in women giving birth. The purpose of this study was to determine the effect of prenatal yoga on perineal rupture. The research method used was a pre-experimental design using an intact-group comparison design. The sample in this study were pregnant women with gestational age above 34 weeks who took part in yoga pregnancy 20 respondents and who did not participate in yoga pregnancy 20 respondents so that the sample size was 40 respondents. Analysis using Chi square. The results showed that prenatal yoga had an effect of 4,333 times on pregnant women to be able to give birth without experiencing perineal rupture compared to pregnant women who did not do yoga. Conclusion: there is an effect of prenatal yoga on perineal rupture.Keywords: Prenatal yoga, Perineal rupture, Pregnant women

8852 Incidence and Risk Factors of Tubal Ruptured Ectopic Pregnancy: An Analysis Based on 10-Year Experience in Our Tertiary Medical Center

<h3>Study Objective</h3> Determine predictors of tubal rupture in women with tubal ectopic pregnancy. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Tertiary university-affiliated hospital. <h3>Patients or Participants</h3> Patients admitted to our center with the diagnosis of tubal ectopic pregnancy between 2006 and 2016. <h3>Interventions</h3> Electronic medical records of all these patients were reviewed and analyzed. Data extraction included demographic, medical history, and laboratory results. The study aimed to assess risk factors and predictors for tubal rupture. Such as past obstetrical and surgical history, demographic characteristics, and serum β-hCG levels. <h3>Measurements and Main Results</h3> A total of 943 women were admitted in the above-mentioned period. Of those, 98 women had a clinical presentation of ruptured tubal pregnancy that was later confirmed by surgery. A comparison was made between the rupture group and 844 women with unruptured tubal pregnancy. Of 943 tubal pregnancies, 10.3% were ruptured. There was no difference in age, gravidity, admission gestational age, admission mean β-hCG levels, and history of previous ectopic pregnancies. There was a statistically significant difference between ruptured and unruptured groups in parity (1.1 vs. 0.81 respectively, P = 0.009) and live children rate (1.09 vs. 0.76, p=0.002). Tubal rupture occurred in any β-hCG level with the lowest level of 179 mIU/ml. although mean β-hCG levels did not differ between groups, we found that β-hCG level above 5000 mIU/ml was significantly higher in the rupture group. (21% vs. 10%, p=0.01) No significant difference was found when comparing tubal pregnancy risk factors such as a history of pelvic infection, IVF pregnancy, smoking, use of IUD or emergency contraceptive, past abdominopelvic surgeries, and endometriosis. <h3>Conclusion</h3> As seen in this large-scale study, women's parity, live children rate, and serum β-hCG levels >or=5,000 mIU/ml may help predict which tubal pregnancy will rupture. further investigation is needed to understand how this knowledge can be assimilated into the clinical decision-making process.

Ruptured ectopic pregnancies following methotrexate treatment: clinical course and predictors for improving patient counseling.

To determine the predictors for tubal rupture among women treated with methotrexate (MTX) for ectopic pregnancy. We performed a retrospective cohort analysis in a tertiary university-affiliated medical center. Medical records of 401 women who were diagnosed with ectopic pregnancy and were treated with MTX between January 2001 and June 2017 were reviewed. Forty-one women were diagnosed with ruptured ectopic pregnancy (study group) and 360 women with non-ruptured ectopic pregnancy (control group). Descriptive data and predictive variables for rupture ectopic pregnancy following MTX treatment were reviewed. Out of 122 women who failed MTX treatment, forty-one women had tubal rupture (33.6%). The median time interval from MTX treatment to tubal rupture was 6days (1-25). β-hCG percentage change in the 48h preceding MTX treatment and β-hCG level at day 0 were independent predictors for tubal rupture (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.04-1.12, p < 0.001 for every percent change in β-hCG; OR = 1.001, 95% CI = 1.0003-1.002 for every unit change in β-hCG, respectively). In a decision tree analysis model, in women with β-hCG percentage increment >69% in the 48h preceding methotrexate the probability for tubal rupture was 85%. Risk assessment for tubal rupture should be made before methotrexate treatment according to β-hCG dynamics and level. The absolute risk for tubal rupture in women with β-hCG increment<20% is low.

Sex Difference and Rupture Rate of Intracranial Aneurysms: An Individual Patient Data Meta-Analysis.

In previous studies, women had a higher risk of rupture of intracranial aneurysms than men, but female sex was not an independent risk factor. This may be explained by a higher prevalence of patient- or aneurysm-related risk factors for rupture in women than in men or by insufficient power of previous studies. We assessed sex differences in rupture rate taking into account other patient- and aneurysm-related risk factors for aneurysmal rupture. We searched Embase and Pubmed for articles published until December 1, 2020. Cohorts with available individual patient data were included in our meta-analysis. We compared rupture rates of women versus men using a Cox proportional hazard regression model adjusted for the PHASES score (Population, Hypertension, Age, Size of Aneurysm, Earlier Subarachnoid Hemorrhage From Another Aneurysm, Site of Aneurysm), smoking, and a positive family history of aneurysmal subarachnoid hemorrhage. We pooled individual patient data from 9 cohorts totaling 9940 patients (6555 women, 66%) with 12 193 unruptured intracranial aneurysms, and 24 357 person-years follow-up. Rupture occurred in 163 women (rupture rate 1.04%/person-years [95% CI, 0.89-1.21]) and 63 men (rupture rate 0.74%/person-years [95% CI, 0.58-0.94]). Women were older (61.9 versus 59.5 years), were less often smokers (20% versus 44%), more often had internal carotid artery aneurysms (24% versus 17%), and larger sized aneurysms (≥7 mm, 24% versus 23%) than men. The unadjusted women-to-men hazard ratio was 1.43 (95% CI, 1.07-1.93) and the adjusted women/men ratio was 1.39 (95% CI, 1.02-1.90). Women have a higher risk of aneurysmal rupture than men and this sex difference is not explained by differences in patient- and aneurysm-related risk factors for aneurysmal rupture. Future studies should focus on the factors explaining the higher risk of aneurysmal rupture in women.

Epidemiology of uterine rupture among pregnant women in China and development of a risk prediction model: analysis of data from a multicentre, cross-sectional study

ObjectivesTo describe the epidemiology of uterine rupture in China from 2015 to 2016 and to build a prediction model for uterine rupture in women with a scarred uterus.SettingA multicentre cross-sectional...

Delayed, Stable Presentation of Complete Uterine Rupture

Complete prelabor ruptures in women with a previous uterine scar are rare but are associated with catastrophic outcomes. Intrauterine fetal demise should be recognized as a sign, not necessarily a sole diagnosis, until other etiologies are excluded.

RELATIONSHIP OF AGE, PARITY AND BIRTH WEIGHT WITH A RUPTURE OF THE PERINEUM OF MATERNAL AT PMB NY. “E”

Maternal Mortality Rate is one indicator of the quality of maternal health services in a country. Preliminary study at PMB Ny. "E" with the documentation method, from 45 mothers giving birth 35 (77.7%) ruptured perineum, 10 (22.2%) did not rupture, 25 spontaneous ruptures (71.4%), ruptured with episiotomy 10 (28.5 %). The purpose of the study was to analyze the relationship between age, parity and birth weight of babies with perineal rupture in women giving birth at PMB Ny. "E" Mojoroto District, Kediri City in 2020.The research design is correlational analytic with a cross sectional approach, a total sample of 66 respondents is sampling, the data is collected through a data collection sheet. The independent variables are age, parity and birth weight of the baby. dependent variable of perineal rupture. Bivariate analysis with Spearman Rho test.Spearman Rho correlation test age p value = 0.001 &lt; 0.05, meaning that there is a relationship between age and perineal rupture. Parity p value = 0.007 &lt; 0.05, meaning that there is a relationship between parity and perineal rupture. Birth weight p value = 0.007 &lt; 0.05, meaning that there is a relationship between birth weight and perineal rupture. Conclusion: There is a relationship between age and perineal rupture. There is a relationship between parity and perineal rupture. There is a relationship between birth weight and perineal rupture.

Ruptured Ectopic Pregnancies Following Methotrexate Treatment: Clinical Course and Predictors for Improving Patient Counseling

<h3>Study Objective</h3> To determine the predictors for tubal rupture among women treated with methotrexate (MTX) for ectopic pregnancy. <h3>Design</h3> Retrospective cohort analysis. <h3>Setting</h3> Tertiary university-affiliated medical center. <h3>Patients or Participants</h3> Four-hundred one women who were diagnosed with ectopic pregnancy and were treated with MTX. Forty-one women with ruptured ectopic pregnancy (study group) and 300 women with non-ruptured ectopic pregnancy (control group). <h3>Interventions</h3> Descriptive data and predictive variables for rupture ectopic pregnancy following MTX treatment. <h3>Measurements and Main Results</h3> Out of 122 women who failed MTX treatment, forty-one women had tubal rupture (33.6%). The median time interval from MTX treatment to tubal rupture was 6 days (1-25). β-hCG percentage change in the 48 hours preceding MTX treatment and β-hCG level at day 0 were independent predictors for tubal rupture (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.04–1.12, p < 0.001 for every percent change in β-hCG; OR = 1.001, 95% CI = 1.0003–1.002 for every unit change in β-hCG, respectively). In a decision tree analysis model, in women with β-hCG percentage increment >69% in the 48 hours preceding methotrexate the probability for tubal rupture was 85%. <h3>Conclusion</h3> Risk assessment for tubal rupture should be made before methotrexate treatment according to β-hCG dynamics and level. The absolute risk for tubal rupture in women with β-hCG increment<20% is low.

Changes in lower uterine segment thickness during different gestational weeks in pregnant women qualified for trial of labor after cesarean section.

ObjectiveTo investigate the correlation between lower uterine segment thickness (LUST) and gestational weeks (GW) in women who attempted trial of labor after cesarean section (TOLAC) and to estimate the reference ranges of LUST.MethodsA prospective cohort study was conducted between January 2019 and December 2020 at a tertiary‐care center in Foshan, China. A total of 2588 women who attempted TOLAC were included. LUST was measured in different trimesters using transabdominal ultrasound. Histograms were used to review the mean and standard deviations (SD) of LUST at different GW.ResultsThe mean LUST of the patients were 6.90 ± 2.86, 4.36 ± 1.87, 2.83 ± 0.65, and 2.57 ± 0.51 mm in the first (12.10 ± 1.28 weeks), second (21.79 ± 3.40 weeks), middle third (34.28 ± 2.64 weeks), and late third (38.20 ± 1.00 weeks) trimesters, respectively. An inverse correlation was noted between LUST and uterine rupture in women who underwent a planned ERCD (P < 0.001), but not in women who attempted TOLAC during the late third trimester (P = 0.629).ConclusionLUST is inversely correlated with GW and decreases faster in the first and second trimesters than in the middle and late third trimesters. TOLAC should be approached with caution for pregnant women with a thin myometrium in late third trimester.

Factors Associated With Achilles Tendon Rupture in Women's Collegiate Gymnastics.

Achilles injury risk in women's collegiate gymnastics is 10-fold higher than in all other collegiate sports. This study aims to identify risk factors for Achilles tendon ruptures in collegiate female gymnasts. Gymnasts with Achilles tendon ruptures will be more likely to report early gymnastics specialization, elite-level training before college, and performance of high-difficulty skills on floor and vault. Cross-sectional study. Level 4. Anonymous surveys were distributed to current and former collegiate female gymnasts, aged 18 to 30 years, via coaches, athletic trainers, Twitter, and ResearchMatch. Information about Achilles tendon ruptures, gymnastics-related injuries, sport specialization, event/skills participation, and medication use were collected. A total of 581 gymnasts were included. One hundred gymnasts (17.2%; 95% CI: 14.1%-20.3%) reported Achilles tendon ruptures during collegiate training or competition. Most ruptures (91%) occurred on floor exercise; 85.7% of these occurred during back tumbling-take-off. Compared with gymnasts without ruptures during college, a greater percentage of gymnasts with ruptures competed at a Division I program, trained elite, competed difficult vaults and floor passes before and during college, competed in all 4 events during college, identified as Black/African American, and used retinoid medications. Achilles tendon ruptures are more common in women's collegiate gymnastics than other sports. Competing at the elite level, performing difficult floor and vault skills, and competing in all 4 events may increase the risk for an Achilles tendon rupture. Potential nontraining risk factors include retinoid exposure and Black/African American race. Future studies regarding the mechanisms of Achilles tendon ruptures in female collegiate gymnasts are warranted. Collegiate gymnasts who compete at the elite level, perform high levels of difficulty on floor and vault, and compete in all 4 events may be at increased risk for Achilles tendon ruptures.

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.

624 Uterine rupture in women with a prior cesarean delivery: labor characteristics

Uterine rupture in women undergoing trial of labor after cesarean (TOLAC) has been associated with labor induction and length. Contemporary definitions of normal labor progress, based on data collected by the Consortium on Safe Labor and depicted by Zhang’s partogram, allow for longer labor duration, but excluded women with a uterine scar. Here, we present labor characteristics of TOLACs complicated by uterine rupture, in the context of contemporary labor management guidelines. This is an observational study of all clinically significant uterine ruptures in women undergoing TOLAC from 2009-2019 at a single tertiary academic center. ICD9/10 code search was used to identify TOLACs complicated by obstetric trauma and/or maternal morbidity, followed by electronic chart review to confirm diagnosis and collect demographic, pregnancy, and labor characteristics. For women with active phase or 2nd stage arrest, the rate of cervical change prior to uterine rupture (1st stage rupture), or prior to complete cervical dilation (2nd stage rupture) was collected and compared to the median and 95th % of Zhang’s partogram. There were 21 uterine ruptures in 1128 TOLACs (1.86%). Table 1 demonstrates maternal and pregnancy characteristics. Most women were induced or augmented (76% and 9.5%, respectively). Uterine ruptures in latent phase, active phase and 2nd stage were similarly distributed. There were no women with prolonged latent phase or second stage. However, the rate of cervical change prior to rupture or prior to complete cervical dilation was beyond the expected median for hourly change 86.7% of the time, though within the 95th% of the Zhang curve in 46.7% of cases (Figure 1). Most women undergoing TOLAC who experienced uterine rupture were exposed to oxytocin, and, when in active phase, demonstrated longer than average hourly cervical change. Contemporary labor management guidelines allowing for longer duration of labor may not be appropriate for patients undergoing TOLAC, particularly in the context of oxytocin administration.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Assessing lateral uterine wall defects and residual myometrial thickness after cesarean section

ObjectiveLateral wall ruptures in women with a history of cesarean section are less common but more complicated than anterior wall ruptures. Residual myometrial thickness (RMT) is believed to be valuable for assessing the probability of ruptures. This study aimed to assess the utility of OmniView (a sonographic reslicing technique) in evaluating the lateral uterine wall after cesarean section and evaluate the relationship between lateral and anterior wall RMT using OmniView and sagittal two-dimensional ultrasound. Study designThis cross-sectional study examined changes in both the anterior and lateral uterine wall in women with a history of cesarean section in the past 12–18 months. OmniView with volume contrast imaging with a 2-mm slice thickness was used to generate coronal planes, and the OmniView RMT (OV-RMT) was calculated as a percentage. Blinded to the OV-RMT results, sonographic multiplanar views were used to acquire the optimum sagittal plane for evaluating the RMT, and the sagittal RMT (S-RMT) was calculated as a percentage. The reproducibility of OV-RMT and S-RMT between two observers was tested using interclass correlation (ICC). The relationship between two variables was tested using Spearman’s rank correlation. ResultsIn 208 recruited patients, the prevalence of lateral uterine wall defects was 79 %. The interobserver and intraobserver reproducibility of S-RMT and OV-RMT had ICC coefficients over 0.9 with a p-value <0.001. S-RMT and OV-RMT did not follow a normal distribution, and the medians were significantly different (55.5 and 85.7, respectively). Spearman’s rank correlation between OV-RMT and S-RMT had a rho (ρ) value of 0.24 (p < 0.05). Passing-Bablok regression had an intercept of 47.95 and a slope of 0.65. ConclusionOmniView can be used to assess lateral uterine wall defects, and OV-RMT is a reproducible and reliable method for quantifying this assessment. The RMT on the coronal plane was independently more intact than that on the sagittal plane, which might account for the lower incidence of lateral ruptures. Further studies could reveal a critical OV-RMT value that is safe for a trial of labor.

Oxytocin use in trial of labor after cesarean and its relationship with risk of uterine rupture in women with one previous cesarean section: a meta-analysis of observational studies.

BackgroundTrial of labor after a previous cesarean delivery (TOLAC) has reduced the rate of cesarean sections (CS). Nevertheless, the widespread use of TOLAC has been limited by an increase in adverse outcomes, the most serious one being the risk of symptomatic uterine rupture, which is possibly associated with oxytocin. In this meta-analysis, we explored the risk association between oxytocin use and uterine rupture in TOLAC.MethodsMultiple electronic databases (PubMed, Embase, Web of Science, and Google Scholar) were searched for cross-sectional studies reporting on TOLAC, oxytocin and uterine rupture, which were published between January 1986 and October 2019. The bias-corrected Hedge’s g was calculated as the effect size using the random-effects model. A two-sample Z test was used to compare the differences in synthetic rates between groups. The Newcastle-Ottawa Scale (NOS) was used to evaluate the risk of bias. Quality of the evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) certainty ratings system.ResultsA total of 14 studies, which included 48,457 women who underwent TOLAC, met the inclusion criteria. The pooled rate of vaginal birth after a cesarean section (VBAC) and the rate of uterine rupture in spontaneous labor were 74.3 and 0.7%, respectively. In addition, the pooled rate of VBAC and the rate of uterine rupture in the induction labor group was 60.7 and 2.2%, respectively. The women who had spontaneous labor had a significantly higher rate of VBAC (p = 0.001) and a lower rate of uterine rupture (p = 0.0003) compared to induced labor. The pooled rates of uterine rupture in women using oxytocin and women not using oxytocin in TOLAC were 1.4% and 0.5%, respectively, and the difference was significant (p = 0.0002). Also, the synthetic rate of uterine rupture in oxytocin augmentation among women with spontaneous labor and women who had a successful induction of labor were 1.7% and 2.2%, respectively, without significant difference (p = 0.443).ConclusionsWomen with induced labor had a higher risk of uterine rupture compared to women with spontaneous labor following TOLAC. Oxytocin use may increase this risk, which could be influenced by the process of induction or individual cervix condition. Consequently, simplified and standardized intrapartum management, precise protocol, and cautious monitoring of oxytocin use in TOLAC are necessary.

Grandmultiparity, Maternal Age, and the Risk for Uterine Rupture—A Multicenter Cohort Study

(Acta Obstet Gynecol Scand. 2020;99:267–273) The rare complication of uterine rupture can potentially result in catastrophic consequences for both mother and fetus. The most common risk factor for uterine rupture is previous cesarean delivery (CD), but few published studies exist addressing uterine rupture in women without a history of previous CD. Conflicting conclusions have been reported regarding any association between grandmultiparity and uterine rupture. In this population, obstetricians have been cautious due to a fear of increased risk for uterine rupture. This approach might trigger the performance of unnecessary CDs. Therefore, this study was undertaken to determine if grandmultiparity is an independent risk factor for intrapartum uterine rupture in women without a history of previous uterine surgery.

Return to Play and Performance After Achilles Tendon Rupture in Women’s National Basketball Association Players

Category:Sports; TraumaIntroduction/Purpose:For the professional athlete, an Achilles tendon rupture is a devastating and potentially career ending injury. Basketball players with Achilles tendon injuries have among the lowest reported return to play rates for orthopaedic injuries. Among National Basketball Association (NBA) players, Achilles rupture has been shown to result in difficulty with returning to competition and significantly decreased productivity exhibiting a large effect size (0.95). Comparable data regarding Women’s National Basketball Association (WNBA) players is lacking. This study evaluated the impact of Achilles tendon rupture on return to play and post-injury performance among WNBA players in order to test the null hypothesis of equal negative impact as observed in the NBA.Methods:This was an IRB exempt retrospective matched cohort study. Public records indicated 12 WNBA players incurred Achilles tendon ruptures between the 2006 and 2018 seasons. Demographic data and performance statistics were collected for pre and post-injury seasons. A control cohort was matched for age, height, weight, years of experience in WNBA, position, and pre-injury player efficiency rating (PER). Individual pre versus post injury and injury cohort versus control cohort performance statistics were compared using paired and independent samples t-tests, respectively. Injury effect size on performance was calculated. The primary outcome was difference in PER. Secondary outcomes included differences in itemized performance statistics. A priori sample size based on effect size of 0.95 indicated that 12 players per cohort were needed for 80% power to detect a difference in PER at alpha of 0.05.Results:7 (58%) players returned to WNBA play by mean 9.5 months. There was no significant difference in pre injury PER from seasons matched for years of WNBA experience between cohorts (13.7 vs 11.9; P = 0.6). Mean PER significantly decreased in the first year (13.66 vs 9.00; P = .04; Cohen’s d = .99) and approached a significance difference in the second year (14.56 vs 9.95; P =05; Cohen’s d = 1.02) in the injured cohort only. Minutes per game (MPG) significantly decreased only year 1 post-injury (25.84 vs 19.54; P = .04; Cohen’s d = 6.56). Points per game (PPG), field goals attempted per game (FGA), and free throws attempted per game (FTA) significantly decreased in both years post-injury (all p < 0.05).Conclusion::WNBA players incurred Achilles tendon ruptures at a rate of 2% annually. This was associated with a moderate rate of return to play and significantly reduced production (PER, MPG, PPG, FGA, and FTA) in the first year. The second season following injury found players returning closer to pre-injury performance, with persistent significant reduction in PPG, FGA, and FTA. Effect sizes were uniformly large. These data were consistent with NBA results, supporting the null hypothesis. Providers may use this data to counsel high and elite level female basketball players on return to play and performance expectations following Achilles tendon ruptures.