Comparative analysis of second- and third-trimester complete uterine rupture cases followed up in a tertiary hospital: a retrospective cohort study

Aim: There are not many studies that compared the uterine rupture cases pertaining to different trimesters of pregnancy in terms of the changes in relevant risk factors and fetomaternal outcomes. In this context, this study was carried out to comparatively analyze the cases who were diagnosed with complete uterine rupture and gave birth in the hospital where this study was conducted in terms of the relevant risk factors and fetomaternal outcomes. Material and Method: The population of this retrospective study consisted of patients who were diagnosed with complete uterine rupture and gave birth in our hospital between January 2015 and June 2022. Patients’ demographic characteristics, cesarean section, labor induction histories, and fetal and maternal outcomes were recorded. The patients included in this study were divided into two groups based on the trimester when the complete uterine rupture occurred as second- and third-trimester complete uterine rupture groups. The groups were compared in terms of fetal, maternal, and obstetric outcomes. Results: Out of the 56718 deliveries performed during the study period, a total of 27 complete uterine rupture cases, of whom 10 had second-, and 17 had third-trimester uterine rupture, were included in the study sample. Accordingly, the incidence of rupture was calculated as 0.047%. Of these 27 cases, 9 had re-pregnancy. Bilateral hypogastric artery ligation was performed in seven patients and six of these patients were in the third trimester rupture group. Of the 27 cases with complete uterine rupture, 19 had a cesarean section history. All 8 cases that did not have a cesarean section history had a complete uterine rupture in the third trimester. Conclusion: Complete uterine rupture is associated with adverse maternal and fetal outcomes. Fertility-sparing surgery (primary repair) is the first-line therapy. The prognosis of second-trimester uterine ruptures is more unfavorable compared to third-trimester uterine ruptures from the fetal point of view yet more favorable from the maternal point of view.

Keywords:

Hysterectomy perinatal mortality, cesarean section, uterine rupture,

PDF

___

Gibbins KJ, Weber T, Holmgren CM, Porter TF, Varner MW, Manuck TA. Maternal and fetal morbidity associated with uterine rupture of the unscarred uterus. Am J Obstet Gynecol 2015; 213: 382.e1-6.
Kaczmarczyk M, Sparén P, Terry P, Cnattingius S. Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population-based study of successive pregnancies in Sweden. BJOG Int J Obstet Gynaecol 2007; 114: 1208–14.
Ofir K, Sheiner E, Levy A, Katz M, Mazor M. Uterine rupture: risk factors and pregnancy outcome. Am J Obstet Gynecol 2003; 189: 1042–6.
Al Qahtani NH, Al Hajeri F. Pregnancy outcome and fertility after complete uterine rupture: a report of 20 pregnancies and a review of literature. Arch Gynecol Obstet 2011; 284: 1123–6.
Lim AC, Kwee A, Bruinse HW. Pregnancy after uterine rupture: a report of 5 cases and a review of the literature. Obstet Gynecol Surv 2005; 60: 613–7.
Ritchie EH. Pregnancy after rupture of the pregnant uterus. A report of 36 pregnancies and a study of cases reported since 1932. J Obstet Gynaecol Br Commonw 1971; 78: 642–8.
Herrera FA, Hassanein AH, Bansal V. Atraumatic spontaneous rupture of the non-gravid uterus. J Emerg Trauma Shock 2011; 4: 439.
Bulletins-Obstetrics Committee. ACOG practice bulletin no. 205: vaginal birth after cesarean delivery. Obstet Gynecol 2019; 133: e110–27.
Zwart JJ, Richters JM, Ory F, de Vries JIP, Bloemenkamp KWM, van Roosmalen J. Uterine rupture in The Netherlands: a nationwide population-based cohort study. BJOG Int J Obstet Gynaecol 2009; 116: 1069–78; discussion 1078-1080.
Daponte A, Nzewenga G, Dimopoulos KD, Guidozzi F. The use of vaginal misoprostol for second-trimester pregnancy termination in women with previous single cesarean section. Contraception 2006; 74: 324–7.
Dickinson JE. Misoprostol for second-trimester pregnancy termination in women with a prior cesarean delivery. Obstet Gynecol 2005105: 352–6.
Morris JL, Winikoff B, Dabash R, et al. FIGO’s updated recommendations for misoprostol used alone in gynecology and obstetrics. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet 2017; 138: 363–6.
Grobman W, Lai Y, London M, et al. Prediction of uterine rupture associated with attempted vaginal birth after cesarean delivery. Am J Obstet Gynecol 2008; 199: 30.
Dekker GA, Chan A, Luke CG, et al. Risk of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: a retrospective population-based cohort study. BJOG Int J Obstet Gynaecol 2010; 117: 1358–65.
Leung AS, Leung EK, Paul RH. Uterine rupture after previous cesarean delivery: maternal and fetal consequences. Am J Obstet Gynecol 1993; 169: 945–50.
Guiliano M, Closset E, Therby D, LeGoueff F, Deruelle P, Subtil D. Signs, symptoms and complications of complete and partial uterine ruptures during pregnancy and delivery. Eur J Obstet Gynecol Reprod Biol 2014; 179: 130–4.
American College of Obstetricians and Gynecologists. Vaginal birth after previous cesarean delivery. ACOG Pract Patterns Bull 1995; 1: 1–8.
Chen LH, Tan KH, Yeo GS. A ten-year review of uterine rupture in modern obstetric practice. Ann Acad Med Singapore 1995; 24: 830–5.
Usta IM, Hamdi MA, Musa AAA, Nassar AH. Pregnancy outcome in patients with previous uterine rupture. Acta Obstet Gynecol Scand 2007; 86: 172–6.