open access
Unscarred uterine rupture and subsequent pregnancy outcome — a tertiary centre experience
- Department of Obstetrics and Gynecology, Dicle University, Faculty of Medicine, Diyarbakır, Türkiye
- Department of Obstetrics and Gynecology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey, Türkiye
- Department of Obstetrics and Gynecology, Adıyaman University, Faculty of Medicine, Adıyaman, Türkiye
open access
Abstract
Objectives: The aim of this study was to investigate the incidence, etiology and obstetric outcomes of rupture in unscarred
uterine rupture and in those with a history of uterine rupture
Material and methods: The hospital records of women who had delivered between May 2005 and May 2017 at a tertiary
center were examined retrospectively. Data on patients with unscarred uterine rupture in pregnancy who had undergone
fertility-preserving surgery were evaluated.
Results: During the study period, 185,609 deliveries occurred. Of those, unscarred uterine rupture has occurred in
67 women. There were no ruptures reported in nulliparous women. The rupture was observed in the isthmic region in
60 (89.6%) patients and in the fundus in 7 (10.4%) patients. Thirty-eight (56.7%) patients had undergone a total or subtotal
hysterectomy, and 29 (43.3%) patients had received primary repair. Ten patients had reconceived after the repair. Of these,
eight patients who had a history of isthmic rupture, successfully delivered by elective C-section at 36–37 wk. of gestation,
and two experienced recurrent rupture at 33 and 34 wk. of gestation, respectively. Both patients had a history of fundal
rupture, and their inter-pregnancy interval was 9 and 11 mo., respectively.
Conclusions: The incidence of rupture in unscarred pregnant uteri was found to be one per 2,770 deliveries. Owing to the
high morbidity, regarding more than half of the cases with rupture eventuated in hysterectomy, clinicians should be prudent
in induction of labour for multiparous women since it was the main cause of rupture in this series. Short inter-pregnancy
intervals and history of fundal rupture may confer a risk for rupture recurrence. Those risk factors for recurrence should be
validated in another studies.
Abstract
Objectives: The aim of this study was to investigate the incidence, etiology and obstetric outcomes of rupture in unscarred
uterine rupture and in those with a history of uterine rupture
Material and methods: The hospital records of women who had delivered between May 2005 and May 2017 at a tertiary
center were examined retrospectively. Data on patients with unscarred uterine rupture in pregnancy who had undergone
fertility-preserving surgery were evaluated.
Results: During the study period, 185,609 deliveries occurred. Of those, unscarred uterine rupture has occurred in
67 women. There were no ruptures reported in nulliparous women. The rupture was observed in the isthmic region in
60 (89.6%) patients and in the fundus in 7 (10.4%) patients. Thirty-eight (56.7%) patients had undergone a total or subtotal
hysterectomy, and 29 (43.3%) patients had received primary repair. Ten patients had reconceived after the repair. Of these,
eight patients who had a history of isthmic rupture, successfully delivered by elective C-section at 36–37 wk. of gestation,
and two experienced recurrent rupture at 33 and 34 wk. of gestation, respectively. Both patients had a history of fundal
rupture, and their inter-pregnancy interval was 9 and 11 mo., respectively.
Conclusions: The incidence of rupture in unscarred pregnant uteri was found to be one per 2,770 deliveries. Owing to the
high morbidity, regarding more than half of the cases with rupture eventuated in hysterectomy, clinicians should be prudent
in induction of labour for multiparous women since it was the main cause of rupture in this series. Short inter-pregnancy
intervals and history of fundal rupture may confer a risk for rupture recurrence. Those risk factors for recurrence should be
validated in another studies.
Keywords
unscarred uterine rupture; recurrent uterine rupture; uterine repair; timing of delivery; pregnancy outcome
Title
Unscarred uterine rupture and subsequent pregnancy outcome — a tertiary centre experience
Journal
Issue
Article type
Research paper
Pages
95-90
Published online
2020-02-10
Page views
2566
Article views/downloads
1617
DOI
Pubmed
Bibliographic record
Ginekol Pol 2020;91(2):95-90.
Keywords
unscarred uterine rupture
recurrent uterine rupture
uterine repair
timing of delivery
pregnancy outcome
Authors
Nurullah Peker
Edip Aydın
Mehmet Sıddık Evsen
Fatma Nur Hançer
Muhammet Hanifi Bademkıran
Serhat Ege
Bekir Kahveci
Talip Karaçor
Talip Gül
- Gibbins K, Weber T, Holmgren C, et al. Maternal and fetal morbidity associated with uterine rupture of the unscarred uterus. American Journal of Obstetrics and Gynecology. 2015; 213(3): 382.e1–382.e6.
- Dow M, Wax J, Pinette M, et al. Third-Trimester Uterine Rupture without Previous Cesarean: A Case Series and Review of the Literature. American Journal of Perinatology. 2009; 26(10): 739–744.
- Porreco R, Clark S, Belfort M, et al. The changing specter of uterine rupture. American Journal of Obstetrics and Gynecology. 2009; 200(3): 269.e1–269.e4.
- Miller DA, Goodwin TM, Gherman RB, et al. Intrapartum rupture of the unscarred uterus. Obstet Gynecol. 1997; 89(5 Pt 1): 671–673.
- Zwart JJ, Richters JM, Öry F, et al. Uterine rupture in the Netherlands: a nationwide population-based cohort study. BJOG: An International Journal of Obstetrics & Gynaecology. 2009; 116(8): 1069–1080.
- You SH, Chang YL, Yen CF. Rupture of the scarred and unscarred gravid uterus: Outcomes and risk factors analysis. Taiwanese Journal of Obstetrics and Gynecology. 2018; 57(2): 248–254.
- Pierzynski P, Laudanski P, Lemancewicz A, et al. Spontaneous rupture of unscarred uterus in the early second trimester: a case report of placenta percreta. Ginekol Pol. 2012; 83(8): 626–629.
- Walsh C, Baxi L. Rupture of the Primigravid Uterus: A Review of the Literature. Obstetrical & Gynecological Survey. 2007; 62(5): 327–334.
- Kapoor DS, Sharma SS, Alfirevic Z. Management of unscarred ruptured uterus. Journal of Perinatal Medicine. 2003; 31(4).
- Wielgos M, Bomba-Opoń D, Breborowicz G, et al. Recommendations of the Polish Society of Gynecologists and Obstetricians regarding caesarean sections. Ginekologia Polska. 2018; 89(11): 644–657.
- Ofir K, Sheiner E, Levy A, et al. Uterine rupture: differences between a scarred and an unscarred uterus. American Journal of Obstetrics and Gynecology. 2004; 191(2): 425–429.
- Wang YL, Su TH. Obstetric Uterine Rupture of the Unscarred Uterus: A Twenty-Year Clinical Analysis. Gynecologic and Obstetric Investigation. 2006; 62(3): 131–135.
- Konje JC, Odukoya OA, Ladipo OA. Ruptured uterus in Ibadan - A twelve year review. International Journal of Gynecology & Obstetrics. 2004; 32(3): 207–213.
- Turgut A, Ozler A, Evsen M, et al. Uterine rupture revisited: Predisposing factors, clinical features, management and outcomes from a tertiary care center in Turkey. Pakistan Journal of Medical Sciences. 2013; 29(3).
- William???s Obstetrics. Academic Medicine. 1936; 11(5): 336.
- Chauhan S, Martin J, Henrichs C, et al. Maternal and perinatal complications with uterine rupture in 142,075 patients who attempted vaginal birth after cesarean delivery: A review of the literature. American Journal of Obstetrics and Gynecology. 2003; 189(2): 408–417.
- Kwee A, Bots M, Visser G, et al. Uterine rupture and its complications in the Netherlands: A prospective study. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2006; 128(1-2): 257–261.
- Zheng J, Liu S, Xing J. Prognosis and related risk factors of patients with scarred uterus complicated with central placenta previa. Ginekologia Polska. 2019; 90(4): 185–188.
- Phelan J, Korst L, Martin G. Causation—Fetal Brain Injury and Uterine Rupture. Clinics in Perinatology. 2007; 34(3): 409–438.
- Dogan O, Pulatoglu C, Yassa M. A new facilitating technique for postpartum hysterectomy at full dilatation: Cervical clamp. Journal of the Chinese Medical Association. 2018; 81(4): 366–369.
- Camuzcuoglu H, Toy H, Vural M, et al. Internal iliac artery ligation for severe postpartum hemorrhage and severe hemorrhage after postpartum hysterectomy. Journal of Obstetrics and Gynaecology Research. 2010; 36(3): 538–543.
- Usta I, Hamdi M, Musa AA, et al. Pregnancy outcome in patients with previous uterine rupture. Acta Obstetricia et Gynecologica Scandinavica. 2007; 86(2): 172–176.
- Lim A, Kwee A, Bruinse H. Pregnancy After Uterine Rupture: A Report of 5 Cases and a Review of the Literature. Obstetrical & Gynecological Survey. 2005; 60(9): 613–617.
- Chibber R, El-Saleh E, Fadhli R, et al. Uterine rupture and subsequent pregnancy outcome – how safe is it? A 25-year study. The Journal of Maternal-Fetal & Neonatal Medicine. 2010; 23(5): 421–424.
- Bujold E, Gauthier R. Risk of Uterine Rupture Associated With an Interdelivery Interval Between 18 and 24 Months. Obstetrics & Gynecology. 2010; 115(5): 1003–1006.