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Uterine rupture over 11 years: A retrospective descriptive study
1Department of Obstetrics and Gynaecology, Waikato District Health Board, Hamilton, New Zealand.
Summary
Uterine rupture is a rare but serious obstetric emergency. This study found a prevalence of 8.4 per 10,000 births in New Zealand, with no maternal deaths but a 16% perinatal death rate.
Area of Science:
- Obstetrics
- Maternal-Fetal Medicine
- Gynecologic Surgery
Background:
- Uterine rupture is a rare obstetric emergency.
- Its incidence is increasing due to higher rates of caesarean section (CS) and trial of labour after CS (TOLAC).
Purpose of the Study:
- To determine the prevalence of complete uterine rupture.
- To identify maternal and neonatal complications associated with uterine rupture.
- To analyze risk factors in a New Zealand tertiary referral hospital over an 11-year period.
Main Methods:
- Retrospective, observational study design.
- Review of patient records at Waikato Hospital from 2008 to 2018.
- Data collection on risk factors, delivery outcomes, and maternal/neonatal complications.
Main Results:
- Prevalence of complete uterine rupture was 8.4 per 10,000 births (95% CI 5.9-11.8).
- No maternal deaths occurred; however, three patients required peripartum hysterectomy and 63% needed blood transfusions.
- There were five perinatal deaths (16% rate).
- Patients with unscarred uteri had lower emergency CS rates but higher postpartum hemorrhage rates compared to those with scarred uteri.
Conclusions:
- The prevalence of uterine rupture in this New Zealand hospital is comparable to international rates.
- While no maternal mortality was observed, a significant perinatal death rate (16%) highlights the severity of this complication.
- Judicious labor management and a high index of suspicion for uterine rupture are crucial for all patient groups, including those with spontaneous labor and unscarred uteri.
