Uterine rupture after previous caesarean section

Al-Zirqi, Iqbal; Stray‐Pedersen, Babill; Forsén, Lisa; Vangen, Siri

doi:10.1111/j.1471-0528.2010.02533.x

Cited by 138 publications

(80 citation statements)

References 47 publications

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“…Previous studies reported the incidences of uterine rupture in women with prior CS from 0.22% to 1.69%34561419 and these were similar to the results of this study, with an overall rate of 0.5%. The incidence of uterine rupture was highest in low-HDI countries (1.0%), and the multivariate analysis identified giving birth in low-HDI countries as a factor associated with uterine rupture.…”

Section: Discussionsupporting

confidence: 91%

“…The reported incidence of uterine rupture among women with prior CS ranged from 0.22% to 0.5% in some developed countries3456. The risk factors for uterine rupture in women with a history of CS include prior classical incision, labour induction or argumentation, macrosomia, increasing maternal age, post-term delivery, short maternal stature, no prior vaginal delivery, and prior periviable CS47891011.…”

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confidence: 99%

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Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health

Motomura

Ganchimeg

Nagata

et al. 2017

Sci Rep

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Caesarean section (CS) is increasing globally, and women with prior CS are at higher risk of uterine rupture in subsequent pregnancies. However, little is known about the incidence, risk factors, and outcomes of uterine rupture in women with prior CS, especially in developing countries. To investigate this, we conducted a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health, which included data on delivery from 359 facilities in 29 countries. The incidence of uterine rupture among women with at least one prior CS was 0.5% (170/37,366), ranging from 0.2% in high-Human Development Index (HDI) countries to 1.0% in low-HDI countries. Factors significantly associated with uterine rupture included giving birth in medium- or low-HDI countries (adjusted odds ratio [AOR] 2.0 and 3.88, respectively), lower maternal educational level (≤6 years) (AOR 1.71), spontaneous onset of labour (AOR 1.62), and gestational age at birth <37 weeks (AOR 3.52). Women with uterine rupture had significantly higher risk of maternal death (AOR 4.45) and perinatal death (AOR 33.34). Women with prior CS, especially in resource-limited settings, are facing higher risk of uterine rupture and subsequent adverse outcomes. Further studies are needed for prevention/management strategies in these settings.

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health

Motomura

Ganchimeg

Nagata

et al. 2017

Sci Rep

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“…Furthermore, our systematic search identified multiple large studies regarding uterine ruptures in which information on the tocogram was not provided, which could entail publication bias. For example, Al-Zirqi et al ( n = 94) and Kwee et al ( n = 98) identified a total of 192 uterine ruptures, yet both studies did not analyze uterine activity patterns [8, 33]. And we excluded the study of Kayani et al, because there was no uterine activity evaluation, while they do report that ‘the intrauterine pressure catheters recording have contributed to the diagnosis of uterine rupture’ [34].…”

Section: Discussionmentioning

confidence: 99%

Tocogram characteristics of uterine rupture: a systematic review

Vlemminx

Lau

Oei

2016

Arch Gynecol Obstet

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PurposeTimely diagnosing a uterine rupture is challenging. Based on the pathophysiology of complete uterine wall separation, changes in uterine activity are expected. The primary objective is to identify tocogram characteristics associated with uterine rupture during trial of labor after cesarean section. The secondary objective is to compare the external tocodynamometer with intrauterine pressure catheters.MethodsMEDLINE, EMBASE, and the Cochrane library were systematically searched for eligible records. Moreover, clinical guidelines were screened. Studies analyzing tocogram characteristics of uterine rupture during trial of labor after cesarean section were appraised and included by two independent reviewers. Due to heterogeneity, a meta-analysis was only feasible for uterine hyperstimulation.ResultsThirteen studies were included. Three tocogram characteristics were associated with uterine rupture. (1) Hyperstimulation was more frequently observed compared with controls during the delivery (38 versus 21 % and 58 versus 53 %), and in the last 2 h prior to birth (19 versus 4 %). Results of meta-analysis: OR 1.68 (95 % CI 0.97–2.89), p = 0.06. (2) Decrease of uterine activity was observed in 14–40 % and (3) an increasing baseline in 10–20 %. Five studies documented no changes in uterine activity or Montevideo units. A direct comparison between external tocodynamometer and intrauterine pressure catheters was not feasible.ConclusionsUterine rupture can be preceded or accompanied by several types of changes in uterine contractility, including hyperstimulation, reduced number of contractions, and increased or reduced baseline of the uterine tonus. While no typical pattern has been repeatedly reported, close follow-up of uterine contractility is advised and hyperstimulation should be prevented.

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“…National guidelines for diagnosis, monitoring and treatment of maternal and fetal complications have been updated regularly since 1995, but lack of adherence has been reported 19–22. Caesarean section also increases the risk of maternal complications both in the actual and subsequent pregnancies 23,24. Within-country variation of caesarean section rates may have an impact on maternal morbidity.…”

Section: Discussionmentioning

confidence: 99%

Availability and access in modern obstetric care: a retrospective population‐based study

Engjom

Morken

Norheim

et al. 2013

BJOG

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Objective To assess the availability of obstetric institutions, the risk of unplanned delivery outside an institution and maternal morbidity in a national setting in which the number of institutions declined from 95 to 51 during 30 years.Design Retrospective population-based, three cohorts and two cross-sectional analyses. Methods Geographic Information Systems software for travel zone calculations. Cross-table and multiple logistic regression analysis of change over time and regional differences. World Health Organization Emergency Obstetric and Newborn Care (EmOC) indicators.Main outcome measures Proportion of women living outside the 1-hour travel zone to obstetric institutions. Risk of unplanned delivery outside obstetric institutions. Maternal morbidity.Results The proportion of women living outside the 1-hour zone for all obstetric institutions increased from 7.9% to 8.8% from 2000 to 2010 (relative risk, 1.1; 95% confidence interval, 1.11-1.12), and for emergency obstetric care from 11.0% to 12.1% (relative risk, 1.1; 95% confidence interval, 1.09-1.11). The risk of unplanned delivery outside institutions increased from 0.4% in 1979-83 to 0.7% in 2004-09 (adjusted odds ratio, 2.0; 95% confidence interval, 1.9-2.2). Maternal morbidity increased from 1.7% in 2000 to 2.2% in 2009 (adjusted odds ratio, 1.4; 95% confidence interval, 1.2-1.5) and the regional differences increased.Conclusions The availability of and access to obstetric institutions was reduced and we did not observe the expected decrease in maternal morbidity following the centralisation.

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Uterine rupture after previous caesarean section

Cited by 138 publications

References 47 publications

Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health

Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health

Tocogram characteristics of uterine rupture: a systematic review

Availability and access in modern obstetric care: a retrospective population‐based study

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