Higher prevalence of complete uterine ruptures per TOLAC was observed in countries with low previous CS and high TOLAC rates. Rates of hysterectomy and perinatal death are about 10% following complete uterine rupture, but in women undergoing TOLAC the rates are extremely low (only 2.2 and 3.2 per 10 000 TOLACs, respectively.) TWEETABLE ABSTRACT: Prevalence of complete uterine rupture is higher in countries with low previous CS and high TOLAC rates.

There is substantial interinstitutional variation in mode of birth following previous caesarean section. This variation is in addition to regional patterns.

The envisaged expansion of GerOSS to an interactive platform will allow dissemination of insights such that optimal obstetric care and transferal among all involved medical facilities may see future enhancements via the internet or even through smartphone applications.

ObjectiveAnalysis of atypical cases of uterine rupture, namely, uterine rupture occurring in unscarred, preterm or prelabour uteri.DesignDescriptive multi‐country population‐based study.SettingTen high‐income countries within the International Network of Obstetric Survey Systems.PopulationWomen with unscarred, preterm or prelabour ruptured uteri.MethodsWe 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.Main Outcome MeasuresIncidence, women's characteristics, presentation and maternal and perinatal outcome.ResultsWe 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%).ConclusionsUterine 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.

The incidence and outcomes of anaphylaxis in pregnancy: a UK population-based descriptive study.Objective: Anaphylaxis is a potentially fatal systemic hypersensitivity reaction, characterised by life -threatening airway, breathing or circulatory problems often with skin or mucosal change. Recent policy changes recommending administration of prophylactic antibiotics prior to caesarean delivery have led to concerns about the maternal and fetal impacts of anaphylactic reactions. The aim of this study was to estimate the incidence of anaphylaxis in pregnancy and describe the management and outcomes in the UK. Methods:A population based descriptive study was completed using the UK Obstetric Surveillance System (UKOSS) between 1 st October 2012 and 30 th September 2015. Cases of anaphylaxis were defined as a severe, life-threatening generalised or systemic hypersensitivity reaction. Results:There were 37 confirmed cases of anaphylaxis in pregnancy, giving an estimated incidence of 1.6 (95%CI 1.1-2.2) per 100,000 maternities. In cases with a single agent recorded, the main causal agents were as follows: penicillin based antibiotics (n=9), cephalosporins (n=1), imidazole (n=1), oxytocin (n=1), anaesthetic agents (n=3), blood products (n=3) and intravenous iron (n=2). There were four cases of anaphylaxis in women with known penicillin allergies: two had received co-amoxiclav and two cephalosporins. Twelve women had anaphylaxis following prophylactic use of antibiotics at the time of a caesarean delivery. Two women died (5%), 14 (38%) women were admitted to intensive care and seven women (19%) had one or more additional severe maternal morbidities, which included three haemorrhagic events, two cardiac arrests, one thrombotic event and one pneumonia. No infants died; however, in those infants whose mother had anaphylaxis before delivery (n=18) there were 7 (41%) neonatal intensive care unit admissions, 3 preterm births and one baby was cooled for neonatal encephalopathy. Conclusions:Anaphylaxis is a rare severe complication of pregnancy and frequently the result of a reaction to antibiotic administration. This study highlights the seriousness of the outcomes of this condition for the mother. The low incidence is reassuring given the large proportion of the pregnant population that receive prophylactic antibiotics during delivery.