Uterine rupture over 11 years: A retrospective descriptive study

Uterine rupture is a rare obstetric emergency, and the rate of rupture has increased over time with the rising rate of caesarean section (CS) and trial of labour after CS (TOLAC).

To determine the prevalence, and maternal and neonatal complications associated with complete uterine rupture at a New Zealand (NZ) tertiary referral hospital over an 11-year period.

This is a retrospective, observational study. Waikato Hospital records of patients with uterine rupture occurring between 2008 and 2018 were reviewed for risk factors, delivery outcomes, and maternal and neonatal complications.

There were 32 patients with complete uterine rupture in 38 182 births, conferring a prevalence of 8.4 per 10 000 births (95% CI 5.9-11.8). Of the 29 cases occurring during labour, 83% of patients were multiparous, 59% previously had one or two CS; patients with an unscarred uterus had lower rates of emergency CS and high rates of postpartum haemorrhage than patients with a scarred uterus. There were no maternal deaths although three patients required peripartum hysterectomy, 63% required blood transfusion and there were five (16%) perinatal deaths.

The prevalence of uterine rupture in this NZ tertiary hospital is comparable to other developed countries. There was no maternal mortality but there was a 16% perinatal death rate. Patients with spontaneous labour and an unscarred uterus were not exempt from this rare complication. There is a need to manage labour judiciously in all patient groups and to maintain a high level of suspicion for uterine rupture.