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Infant outcome after complete uterine rupture.
Iqbal Al-Zirqi1, Anne Kjersti Daltveit2, Siri Vangen3
1Norwegian National Advisory Unit on Women's Health, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Women and Children's Division, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
American Journal of Obstetrics and Gynecology
|April 16, 2018
Summary
Complete uterine rupture is a rare but serious complication. Rapid delivery within 20 minutes and avoiding placental separation significantly reduce infant mortality in these high-risk births.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Reproductive Health
Background:
- Complete uterine rupture is a rare peripartum complication with severe maternal and infant consequences.
- Limited data exists on outcomes due to rarity and diagnostic coding issues.
- Increasing cesarean delivery rates worldwide may lead to a rise in uterine ruptures.
Purpose of the Study:
- To explore risk factors associated with poor infant outcomes in cases of complete uterine rupture.
- To analyze trends in infant mortality over time.
- To identify critical delivery time intervals and associated events impacting infant survival.
Main Methods:
- Population-based study using Norwegian registries (1967-2008) of 244 complete uterine ruptures among 2.4 million births.
- Medical record review for detailed analysis of uterine ruptures.
- Logistic regression to assess associations between infant outcomes and risk factors.
Main Results:
- Infant mortality decreased significantly from 51.6% (1967-1977) to 15.0% (2000-2008).
- Placental separation/fetal extrusion (OR 17.9) and delivery >30 minutes (OR 16.7) were strongly associated with intrapartum/infant deaths.
- Delivery within 20 minutes was associated with the lowest incidence of intrapartum/infant deaths (9.9%).
Conclusions:
- Intrapartum/infant death rates following complete uterine rupture have declined over decades.
- Delivery time >30 minutes and placental separation/fetal extrusion are key risk factors for infant mortality.
- Prompt delivery (<20 minutes) is crucial for improving infant outcomes in complete uterine rupture cases.
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