Uterine rupture: risk factors and pregnancy outcome.
OBJECTIVE
This study aimed at determining risk factors and pregnancy outcome in women with uterine rupture.


METHODS
We conducted a population-based study, comparing all singleton deliveries with and without uterine rupture between 1988 and 1999.


RESULTS
Uterus rupture occurred in 0.035% (n=42) of all deliveries included in the study (n=117,685). Independent risk factors for uterine rupture in a multivariable analysis were as follows: previous cesarean section (odds ratio [OR]=6.0, 95% CI 3.2-11.4), malpresentation (OR=5.4, 95% CI 2.7-10.5), and dystocia during the second stage of labor (OR=13.7, 95% CI 6.4-29.3). Women with uterine rupture had more episodes of postpartum hemorrhage (50.0% vs 0.4%, P<.01), received more packed cell transfusions (54.8% vs 1.5%, P<.01), and required more hysterectomies (26.2% vs 0.04%, P<.01). Newborn infants delivered after uterine rupture were more frequently graded Apgar scores lower than 5 at 5 minutes and had higher rates of perinatal mortality when compared with those without rupture (10.3% vs 0.3%, P<.01; 19.0% vs 1.4%, P<.01, respectively).


CONCLUSIONS
Uterine rupture, associated with previous cesarean section, malpresentation, and second-stage dystocia, is a major risk factor for maternal morbidity and neonatal mortality. Thus, a repeated cesarean delivery should be considered among parturients with a previous uterine scar, whose labor failed to progress.
Department of Obstetrics and Gynecology, Faculty of Health Services, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Keren
K
Ofir
Eyal
E
Sheiner
Amalia
A
Levy
Miriam
M
Katz
Moshe
M
Mazor
D000328:Adult; D002585:Cesarean Section; D017604:Cesarean Section, Repeat; D004420:Dystocia / Q000150:complications; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007746:Labor Presentation; D007748:Labor Stage, Second; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors; D014597:Uterine Rupture / Q000150:complications* / Q000209:etiology