Uterine rupture

Murphy, Deirdre J.

doi:10.1097/01.gco.0000192989.45589.57

Cited by 39 publications

(23 citation statements)

References 34 publications

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“…This finding may be related to the thorough assessment of a single center-database. Rupture in patients with previous uterine surgery was seen in 2.04% (15 of 737), compared to 0.9%-1% in other large retrospective studies [3,20]. Also in the subgroup of women with an unscarred uterus, in our collective a higher incidence of uterine rupture was observed as compared to the published incidence in other studies (0.067% vs. 0.02%-0.006%) [3][4][5].…”

Section: Discussioncontrasting

confidence: 54%

Risk factors of uterine rupture with a special interest to uterine fundal pressure

Sturzenegger

Schäffer

Zimmermann

et al. 2017

Journal of Perinatal Medicine

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PURPOSE Uterine rupture is a rare but serious event with a median incidence of 0.09%. Previous uterine surgery is the most common risk factor. The aim of our study was to analyze retrospectively women with uterine rupture during labor and to evaluate postulated risk factors such as uterine fundal pressure (UFP). METHODS Twenty thousand one hundred and fifty-two deliveries were analyzed retrospectively. Inclusion criteria were 22 weeks and 0 days-42 weeks and 0 days of gestation, singleton pregnancy and cephalic presentation. Women with primary cesarean section were excluded. A logistic regression analysis adjusting for possible risk factors was conducted and a subgroup analysis of women with unscarred uterus was performed. RESULTS Twenty-eight cases of uterine rupture were identified (incidence: 0.14%). Uterine rupture was noticed in multipara patients only. In the multivariate analysis among all study patients, only previous cesarean section remained a statistically significant risk factor [adjusted odds ration (adj. OR) 12.52 confidence interval (CI) 95% 5.21-30.09]. In the subgroup analysis among women with unscarred uterus (n=19,415) three risk factors were associated with uterine rupture: UFP (adj. OR 5.22 CI 95% 1.07-25.55), abnormal placentation (adj. OR 20.82 CI 95% 2.48-175.16) and age at delivery >40 years (adj. OR 4.77 CI 95% 1.44-15.85). CONCLUSIONS The main risk factor for uterine rupture in the whole study population is previous uterine surgery. Risk factors in women with unscarred uterus were UFP, abnormal placentation, and age at delivery >40 years. The only factor which can be modified is UFP. We suggest that UFP should be used with caution at least in presence of other supposed risk factors. AbstractPurpose: Uterine rupture is a rare but serious event with a median incidence of 0.09%. Previous uterine surgery is the most common risk factor. The aim of our study was to analyze retrospectively women with uterine rupture during labor and to evaluate postulated risk factors such as uterine fundal pressure (UFP). Methods: Twenty thousand one hundred and fifty-two deliveries were analyzed retrospectively. Inclusion criteria were 22 weeks and 0 days-42 weeks and 0 days of gestation, singleton pregnancy and cephalic presentation. Women with primary cesarean section were excluded. A logistic regression analysis adjusting for possible risk factors was conducted and a subgroup analysis of women with unscarred uterus was performed. Results: Twenty-eight cases of uterine rupture were identified (incidence: 0.14%). Uterine rupture was noticed in multipara patients only. In the multivariate analysis among all study patients, only previous cesarean section remained a statistically significant risk factor [adjusted odds ration (adj. OR) 12.52 confidence interval (CI) 95% 5.21-30.09]. In the subgroup analysis among women with unscarred uterus (n = 19,415) three risk factors were associated with uterine rupture: UFP (adj. OR 5.22 CI 95% 1.07-25.55), abnormal placentation ) and age at delivery > 40 year...

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Section: Discussioncontrasting

confidence: 54%

Risk factors of uterine rupture with a special interest to uterine fundal pressure

Sturzenegger

Schäffer

Zimmermann

et al. 2017

Journal of Perinatal Medicine

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“…3 Previous caesarean section is the main risk factor for uterine rupture. 1,[4][5][6] Because the rate of caesarean section is increasing worldwide, we are dealing with an increasing number of mothers with previous caesarean section, with consequent higher risk of uterine rupture. 7 The percentage of uterine rupture after trial of labour (TOL) remains low (<1%), with different starts to birth after previous caesarean section.…”

Section: Introductionmentioning

confidence: 99%

Uterine rupture after previous caesarean section

Al-Zirqi

Stray‐Pedersen

Forsén

et al. 2010

BJOG

138

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“…A uterine rupture is very exceptional in developed countries and more frequent in developing countries due to prolonged labor caused by fetomaternal disproportion or secondstage disorders [2]. In developed countries, uterine rupture is almost exclusively observed following a previous cesarean section or previous surgery on the uterus, including myomectomy [59].…”

Section: Discussionmentioning

confidence: 99%

“…A laparotomic or laparoscopic approach will, in most cases, cause a scar in the myometrium, which may lead to weakening of the muscular wall and, by consequence, may increase the risk for the obstetric calamity of the sudden uterine rupture [1]. Nevertheless, it is at the present unclear whether an elective cesarean section may prevent all cases of uterine rupture during labor after previous scarring of the uterus [2].…”

Section: Introductionmentioning

confidence: 97%

The risk of uterine rupture after myomectomy: a systematic review of the literature and meta-analysis

et al. 2014

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Fibroids may give rise to specific obstetrical complications such as pain due to degeneration, fetal malpresentation, or placenta previa. For all these reasons, surgical resection of the fibroid may be indicated before a pregnancy is pursued. The occurrence of a uterine rupture is a rare but severe complication of myomectomy. This study seeks to review the risk of uterine rupture during pregnancy and/or labor after laparoscopic myomectomy in comparison with laparotomic myomectomy. A systematic search of the literature through search strategies in MEDLINE (PubMed) and Embase (Embase.com) from January 1970 up to March 2013 was performed. We used the following MeSH terms and free text words: gynecologic surgical procedures, gynecologic surgery, leiomyoma, fibromyoma, fibroids, myoma, uterine tumors, and pregnancy complication. Our data show that the risk of uterine rupture during labor and delivery is low (0.75 %). Compared with traditional open myomectomy, the risk of uterine rupture during pregnancy is not significantly higher after a laparoscopic approach (P=0.119). More elective cesarean sections are performed after laparoscopic myomectomy compared with the conventional open technique (P= 0.001). Our conclusions are supported by statistical pooling of observational studies of generally low methodological quality. The risk of uterine rupture after myomectomy is low (0.75 %). The available evidence in the literature does no allow discouraging attempts for childbirth per viam naturalem after previous myomectomy, regardless of the technique used.Randomized studies are needed before definitive evidencebased recommendations can be given.

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Uterine rupture

Abstract: Uterine rupture remains one of the most frightening complications in obstetric care. The risk of its occurrence is likely to increase for many parous women, placing the emphasis on counselling and early prediction and prevention wherever possible.

Cited by 39 publications

References 34 publications

Risk factors of uterine rupture with a special interest to uterine fundal pressure

Risk factors of uterine rupture with a special interest to uterine fundal pressure

Uterine rupture after previous caesarean section

The risk of uterine rupture after myomectomy: a systematic review of the literature and meta-analysis

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