open access

Vol 91, No 2 (2020)
ORIGINAL PAPERS Obstetrics
Published online: 2020-02-10
Get Citation

Unscarred uterine rupture and subsequent pregnancy outcome — a tertiary centre experience

Nurullah Peker, Edip Aydın, Mehmet Sıddık Evsen, Fatma Nur Hançer, Muhammet Hanifi Bademkıran, Serhat Ege, Bekir Kahveci, Talip Karaçor, Talip Gül
DOI: 10.5603/GP.a2020.0012
·
Pubmed: 32083306
·
Ginekol Pol 2020;91(2):95-90.

open access

Vol 91, No 2 (2020)
ORIGINAL PAPERS Obstetrics
Published online: 2020-02-10

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.

Get Citation

Keywords

unscarred uterine rupture; recurrent uterine rupture; uterine repair; timing of delivery; pregnancy outcome

About this article
Title

Unscarred uterine rupture and subsequent pregnancy outcome — a tertiary centre experience

Journal

Ginekologia Polska

Issue

Vol 91, No 2 (2020)

Pages

95-90

Published online

2020-02-10

DOI

10.5603/GP.a2020.0012

Pubmed

32083306

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

References (25)
  1. 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.
  2. 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.
  3. 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.
  4. Miller DA, Goodwin TM, Gherman RB, et al. Intrapartum rupture of the unscarred uterus. Obstet Gynecol. 1997; 89(5 Pt 1): 671–673.
  5. 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.
  6. 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.
  7. 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.
  8. Walsh C, Baxi L. Rupture of the Primigravid Uterus: A Review of the Literature. Obstetrical & Gynecological Survey. 2007; 62(5): 327–334.
  9. Kapoor DS, Sharma SS, Alfirevic Z. Management of unscarred ruptured uterus. Journal of Perinatal Medicine. 2003; 31(4).
  10. 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.
  11. 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.
  12. 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.
  13. Konje JC, Odukoya OA, Ladipo OA. Ruptured uterus in Ibadan - A twelve year review. International Journal of Gynecology & Obstetrics. 2004; 32(3): 207–213.
  14. 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).
  15. William???s Obstetrics. Academic Medicine. 1936; 11(5): 336.
  16. 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.
  17. 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.
  18. 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.
  19. Phelan J, Korst L, Martin G. Causation—Fetal Brain Injury and Uterine Rupture. Clinics in Perinatology. 2007; 34(3): 409–438.
  20. 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.
  21. 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.
  22. 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.
  23. 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.
  24. 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.
  25. 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.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl