Incidence, Risk Factors, and Outcomes of Complete Uterine Rupture: A 10-Year Single-Center Retrospective Study

This study aims to analyze the incidence, risk factors, clinical presentations, and maternal-perinatal outcomes of complete uterine rupture at a major tertiary hospital in China over a decade.

We conducted a single-center retrospective cohort study of all women who delivered at our hospital, from March 2012 to February 2022. Cases of complete uterine rupture, defined as a full-thickness tear of the uterine wall confirmed intraoperatively, were identified. Data on demographics, obstetric history, clinical manifestations, management, and outcomes were extracted and analyzed using descriptive statistics.

Out of 232,563 total deliveries, 38 cases of complete uterine rupture were confirmed, yielding an incidence of 0.016% (1.6 per 10,000 deliveries). The median maternal age was 31 years (range, 23-38), and the median gestational age at rupture was 36⁺⁴ weeks (range, 13⁺⁶-40⁺⁶). A prior uterine scar was the predominant risk factor, present in 32 cases (84.2%), primarily from previous cesarean sections. Rupture occurred in unscarred uteri in 6 cases (15.8%). Clinical presentation was highly variable: acute abdominal pain was the most common symptom (n = 20, 52.6%), followed by vaginal bleeding (n = 8, 21.1%) and fetal heart rate abnormalities (n = 10, 26.3%). Notably, 8 patients (21.1%) were asymptomatic, with the rupture discovered incidentally during elective cesarean section. Maternal morbidity was significant, although all mothers survived; however, the perinatal mortality rate was high at 27.5% (11 of 40 fetuses/newborns). Thirty-seven (97.4%) patients underwent uterine repair, and one (2.6%) required a hysterectomy.

A prior uterine scar is the leading risk factor for complete uterine rupture. However, the heterogeneous clinical presentation, including a significant proportion of asymptomatic cases, poses a major diagnostic challenge. A high index of suspicion is crucial for timely intervention to mitigate adverse maternal and perinatal outcomes.