Grandmultiparity, maternal age, and the risk for uterine rupture—A multicenter cohort study

Abstract

Introduction:Uterine rupture is a critical complication causing fetal and maternal morbidity and mortality. Data are conflicting regarding whether grandmultiparity (parity ≥ 6) is a risk factor. This multicenter cohort study aimed to determine whether grandmultiparity (parity ≥ 6) poses a risk for uterine rupture in women with no previous cesarean delivery. Material and methods:A multicenter retrospective study of deliveries that occurred between the years 2003 and 2015 in three tertiary medical centers. Deliveries of grandmultiparous women were compared with those of multiparous women (parity 2-5). Women with previous cesarean deliveries were excluded. Multivariable regression modeling was applied to control for possible confounders.Results: A total of 388 784 deliveries of multiparous women with unscarred uteri were recorded during the study period, including 53 965 deliveries of grandmultiparous women and 334 819 deliveries of multiparous women. Grandmultiparous women were significantly older (33.9 ± 5 vs 27.3 ± 5 years; P < 0.0001). Fourteen cases of uterine rupture were recorded in the grandmultiparae group (1 per 3855 labors) vs 41 in the multiparae group (1 per 8166 labors) (odds ratio [OR] 2.07, 95% confidence interval [95% CI] 1.13-3.81; P = 0.030). However, in a multivariable model controlling for maternal age, the association between grandmultiparity and uterine rupture lost its significance (adjusted OR 1.26, 95% CI 0.66-2.41; P = 0.491), and maternal age emerged as an independent predictor of uterine rupture (adjusted OR 1.08, 95% CI 1.04-1.13; P < 0.0001). Additionally, the risk for uterine rupture was elevated in a linear fashion, concomitant with age. Conclusions:Maternal age is a risk factor for uterine rupture. Grandmultiparity does not increase the risk beyond that associated with maternal age. K E Y W O R D Sbirth order, grandmultiparity, maternal age, unscarred uterus, uterine rupture 268 | HOCHLER Et aL.

Prevalence and determinants of uterine rupture in Ethiopia: a systematic review and meta-analysis

“…This study also revealed women who were para one were 88% less likely to have uterine rupture than women with multiparity. This finding is supported by different prior studies in different countries in Ethiopia 42 , Norway 8 , 69 , Senegal and Mali 56 , Uganda 51 , and Israel 70 . It might be attributed to the fact as increasing parity increases the elasticity and strength of the uterine muscle (Myometrium) decreases 38 , 71 .…”

Comparison of Fetomaternal Complications in Women of High Parity with Women of Low Parity among Saudi Women

“…The WHO defined low parity (LP) women as those having less than five pregnancies (live or stillborn) with gestation periods of ≥20 weeks, and high parity (HP) women were defined as those having five or more pregnancies (live or stillborn) with gestation periods of ≥20 weeks [ 1 , 2 ]. Hence, the term LP includes primipara and multipara, while HP includes grandmultipara and great grandmultipara.…”

“…HP decreased in the Western part of world and its prevalence is around 4%, but in the Eastern part of the world, HP is around 10.2%, which is more than double [ 2 ]. HP is associated with risks of maternal and fetal complications, such as gestational diabetes mellitus (GDM), hypertensive disorders, maternal anemia, preterm labor, miscarriage, postpartum hemorrhage, congenital malformations, macrosomia, and perinatal and preterm mortality [ 3 , 4 , 5 ].…”

“…HP is associated with risks of maternal and fetal complications, such as gestational diabetes mellitus (GDM), hypertensive disorders, maternal anemia, preterm labor, miscarriage, postpartum hemorrhage, congenital malformations, macrosomia, and perinatal and preterm mortality [ 3 , 4 , 5 ]. Maternal age must be considered as a confounder while interpreting the risk of maternal and neonatal complications in HP women [ 2 , 4 ].…”

Spontaneous Antepartum Posterior Wall Uterine Rupture in an Unknown Pregnancy

“…Spontaneous rupture has been reported after uterine artery embolization or in unscarred uterus as well. Maternal age has also been associated with increased risk(6)(7)(8)(9)(10).…”