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Maternal outcome after complete uterine rupture.

Iqbal Al-Zirqi1,2, Anne Kjersti Daltveit3,4, Siri Vangen1,5

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Summary

Complete uterine rupture is a rare but serious complication. Unscarred uteri, older maternal age, high parity, and rupture detection after vaginal delivery increase the risk of peripartum hysterectomy.

Keywords:
complete uterine rupturematernal outcomeperipartum hysterectomyrisk factorsscarred uterisevere postpartum hemorrhageunscarred uteri

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Reproductive Health

Background:

  • Complete uterine rupture is a rare peripartum complication with potentially catastrophic outcomes for mother and child.
  • Studies on maternal outcomes, especially in unscarred uteri, are limited due to the event's rarity and severe consequences like peripartum hysterectomy and maternal death.
  • The rising cesarean section rates worldwide are expected to increase the incidence of uterine rupture, necessitating a better understanding of maternal outcomes.

Purpose of the Study:

  • To identify maternal outcomes following complete uterine ruptures.
  • To determine the risk factors associated with severe maternal outcomes, particularly peripartum hysterectomy, after complete uterine rupture.

Main Methods:

  • Population-based study utilizing data from the Medical Birth Registry of Norway and the Patient Administration System (1967-2008).
  • Inclusion of 247 births with complete uterine rupture identified through registry data and medical record review.
  • Logistic regression analyses (crude and multivariable) were performed to estimate associations between maternal outcomes and demographic/labor risk factors.

Main Results:

  • Among 247 complete uterine ruptures, outcomes included 35.6% healthy mothers, 43.3% severe postpartum hemorrhage without hysterectomy, 20.6% peripartum hysterectomies, and 1.2% maternal deaths.
  • Unscarred uterine ruptures significantly increased the risk of peripartum hysterectomy (Adjusted Odds Ratio [AOR] 2.6).
  • Additional risk factors for peripartum hysterectomy included maternal age ≥35 years (AOR 2.3), parity ≥3 (AOR 2.8), and rupture detection after vaginal delivery (AOR 2.2).

Conclusions:

  • Unscarred uteri, advanced maternal age, high parity (≥3), and detection of rupture after vaginal delivery are key factors associated with an increased risk of peripartum hysterectomy.
  • These findings highlight critical risk factors that can inform clinical management and prevention strategies for complete uterine rupture.
  • The study underscores the importance of recognizing these risk factors to mitigate severe maternal morbidity and mortality associated with uterine rupture.