Uterine rupture and dehiscence: ten-year review and case-control study.
BACKGROUND
Previous cesarean section, oxytocin administration, and fetal macrosomia increase the risk of uterine rupture or dehiscence (URD).


METHODS
All 25,718 deliveries at Riverside Regional Medical Center from January 1990 to June 2000 were reviewed to describe complications and identify risk factors for URD.


RESULTS
Eleven uterine ruptures and 10 dehiscences occurred during this period (0.08%). One maternal death (5%) and three neonatal deaths (14%) occurred. Other complications included intrapartum nonreassuring fetal status (67%), 5-minute Apgar score < 7 (52%), maternal blood transfusion (24%), neonatal hypoxic injury (14%), hysterectomy (14%), and endometritis (10%). Uterine rupture/dehiscence was independently associated with fetal weight > or = 4,000 g, nonreassuring fetal status, use of oxytocin, and previous cesarean delivery; internal fetal monitoring reduced the risk of URD.


CONCLUSIONS
To reduce the risk of URD, a delivery plan should include assessment of cesarean history and fetal macrosomia,judicious use of oxytocin, and intrapartum monitoring for nonreassuring fetal status.
Diaz
Sumac D
SD
Department of Obstetrics and Gynecology, Riverside Regional Medical Center, Newport News, VA, USA.
Jones
Jacob E
JE
Seryakov
Michael
M
Mann
William J
WJ
D000293:Adolescent; D000328:Adult; D001034:Apgar Score; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D005320:Fetal Macrosomia / Q000150:complications*; D005323:Fetal Monitoring; D020567:Fetal Weight; D006801:Humans; D007231:Infant, Newborn; D010121:Oxytocin / Q000009:adverse effects*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology* / Q000517:prevention & control; D013997:Time Factors; D014597:Uterine Rupture / Q000209:etiology* / Q000517:prevention & control
D010121:Oxytocin