Clinical characteristics of uterine rupture without previous Cesarean section: A 25-year retrospective study

To investigate the clinical characteristics and risk factors of uterine rupture without preceding Cesarean section.

The medical records of all deliveries at the Women's Hospital, Zhejiang University School of Medicine between 1992 and 2017 were reviewed. All cases of uterine rupture without previous Cesarean delivery were included. Two types of uterine rupture, incomplete and complete, were distinguished. The clinical characteristics of each patient were collected and analyzed, including demographic information, clinical manifestation, operative records, site of rupture, pregnancy and labor complication, obstetrics risk factors, and birth outcome.

There were 222 418 deliveries in total during the study period. Nineteen cases of uterine rupture without previous Cesarean section were identified. As a result, the incomplete rupture group had significant advanced gestational age, decreased maternal gravidity, lower incidence of dilation and curettage, and lower perinatal mortality rate. In aspect of the rupture site, the involvement of the lower segment of the uterus was significantly more common in the incomplete rupture group. In the complete rupture group, the participants with a gestation age less than 28 weeks were more likely to have a history of dilation and curettage than those with a gestation age over 28 weeks.

The history of dilation and curettage is the major risk factor of uterine rupture without Cesarean section. Our findings imply that obstetricians should be cautious of spontaneous uterine rupture in pregnant women who has a history of dilation and curettage.