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Uterine rupture and dehiscence: ten-year review and case-control study
Sumac D Diaz1, Jacob E Jones, Michael Seryakov
1Department of Obstetrics and Gynecology, Riverside Regional Medical Center, Newport News, VA, USA.
Background:
Previous cesarean section, oxytocin administration, and fetal macrosomia increase the risk of uterine rupture or dehiscence (URD).
Methods:
All 25,718 deliveries at Riverside Regional Medical Center from January 1990 to June 2000 were reviewed to describe complications and identify risk factors for URD.
Results:
Eleven uterine ruptures and 10 dehiscences occurred during this period (0.08%). One maternal death (5%) and three neonatal deaths (14%) occurred. Other complications included intrapartum nonreassuring fetal status (67%), 5-minute Apgar score < 7 (52%), maternal blood transfusion (24%), neonatal hypoxic injury (14%), hysterectomy (14%), and endometritis (10%). Uterine rupture/dehiscence was independently associated with fetal weight > or = 4,000 g, nonreassuring fetal status, use of oxytocin, and previous cesarean delivery; internal fetal monitoring reduced the risk of URD.
Conclusions:
To reduce the risk of URD, a delivery plan should include assessment of cesarean history and fetal macrosomia,judicious use of oxytocin, and intrapartum monitoring for nonreassuring fetal status.