TY - JOUR
T1 - Incidence and outcomes of uterine rupture in women with unscarred, preterm or prelabour uteri
T2 - data from the international network of obstetric survey systems
AU - Vierin, A.
AU - Vandenberghe, G.
AU - Bloemenkamp, K.
AU - Berlage, S.
AU - Colmorn, L.
AU - Deneux-Tharaux, C.
AU - Donati, S.
AU - Gissler, M.
AU - Knight, M.
AU - Langhoff-Roos, J.
AU - Lindqvist, P. G.
AU - Maier, B.
AU - van Roosmalen, J.
AU - INOSS (the International Network of Obstetrics Survey Systems)
AU - Zwart, J.
AU - Roelens, K.
N1 - Funding Information: The authors thank the clinicians and research staff involved in the AuOSS study (Austria), the B.OSS study (Belgium), the GerOSS (Germany), EPIMOMS Study (France), the ItOSS network (Italy), the NOSS (Denmark, Finland and Sweden), the LEMMON study or NethOSS (the Netherlands), the UKOSS (UK). We also thank the women who provided their data. Funding Information: GV was funded by the Research Foundation Flanders (FWO) (2015–2016). Publisher Copyright: © 2023 John Wiley & Sons Ltd.
PY - 2023/11
Y1 - 2023/11
N2 - Objective: Analysis of atypical cases of uterine rupture, namely, uterine rupture occurring in unscarred, preterm or prelabour uteri. Design: Descriptive multi-country population-based study. Setting: Ten high-income countries within the International Network of Obstetric Survey Systems. Population: Women with unscarred, preterm or prelabour ruptured uteri. Methods: We merged prospectively collected individual patient data in ten population-based studies of women with complete uterine rupture. In this analysis, we focused on women with uterine rupture of unscarred, preterm or prelabour ruptured uteri. Main Outcome Measures: Incidence, women's characteristics, presentation and maternal and perinatal outcome. Results: We identified 357 atypical uterine ruptures in 3 064 923 women giving birth. Estimated incidence was 0.2 per 10 000 women (95% CI 0.2–0.3) in the unscarred uteri, 0.5 (95% CI 0.5–0.6) in the preterm uteri, 0.7 (95% CI 0.6–0.8) in the prelabour uteri, and 0.5 (95% CI 0.4–0.5) in the group with no previous caesarean. Atypical uterine rupture resulted in peripartum hysterectomy in 66 women (18.5%, 95% CI 14.3–23.5%), three maternal deaths (0.84%, 95% CI 0.17–2.5%) and perinatal death in 62 infants (19.7%, 95% CI 15.1–25.3%). Conclusions: Uterine rupture in preterm, prelabour or unscarred uteri are extremely uncommon but were associated with severe maternal and perinatal outcome. We found a mix of risk factors in unscarred uteri, most preterm uterine ruptures occurred in caesarean-scarred uteri and most prelabour uterine ruptures in ‘otherwise’ scarred uteri. This study may increase awareness among clinicians and raise suspicion of the possibility of uterine rupture under these less expected conditions.
AB - Objective: Analysis of atypical cases of uterine rupture, namely, uterine rupture occurring in unscarred, preterm or prelabour uteri. Design: Descriptive multi-country population-based study. Setting: Ten high-income countries within the International Network of Obstetric Survey Systems. Population: Women with unscarred, preterm or prelabour ruptured uteri. Methods: We merged prospectively collected individual patient data in ten population-based studies of women with complete uterine rupture. In this analysis, we focused on women with uterine rupture of unscarred, preterm or prelabour ruptured uteri. Main Outcome Measures: Incidence, women's characteristics, presentation and maternal and perinatal outcome. Results: We identified 357 atypical uterine ruptures in 3 064 923 women giving birth. Estimated incidence was 0.2 per 10 000 women (95% CI 0.2–0.3) in the unscarred uteri, 0.5 (95% CI 0.5–0.6) in the preterm uteri, 0.7 (95% CI 0.6–0.8) in the prelabour uteri, and 0.5 (95% CI 0.4–0.5) in the group with no previous caesarean. Atypical uterine rupture resulted in peripartum hysterectomy in 66 women (18.5%, 95% CI 14.3–23.5%), three maternal deaths (0.84%, 95% CI 0.17–2.5%) and perinatal death in 62 infants (19.7%, 95% CI 15.1–25.3%). Conclusions: Uterine rupture in preterm, prelabour or unscarred uteri are extremely uncommon but were associated with severe maternal and perinatal outcome. We found a mix of risk factors in unscarred uteri, most preterm uterine ruptures occurred in caesarean-scarred uteri and most prelabour uterine ruptures in ‘otherwise’ scarred uteri. This study may increase awareness among clinicians and raise suspicion of the possibility of uterine rupture under these less expected conditions.
KW - caesarean
KW - dehiscence
KW - hysterectomy
KW - pregnancy
KW - prelabour uterine rupture
KW - preterm uterine rupture
KW - scar
KW - unscarred uteri
KW - uterine rupture
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U2 - 10.1111/1471-0528.17517
DO - 10.1111/1471-0528.17517
M3 - Article
C2 - 37113103
SN - 1470-0328
VL - 130
SP - 1493
EP - 1501
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
IS - 12
ER -