The changing specter of uterine rupture.
OBJECTIVE
The objective of the study was to review all patient records discharged with codes for uterine rupture in 2006 in Hospital Corporation of America hospitals.


METHODS
All patient charts were distributed to a committee of perinatologists and general obstetricians. Case report forms were analyzed for variables of interest to determine validity of coding and quality of care.


RESULTS
Of 69 cases identified, only 41 were true ruptures. Twenty patients had previous cesareans, and in 9 of these patients, concurrent use of oxytocics was documented. Among the 21 patients without previous cesareans, 7 had previous uterine surgery, and oxytocics were documented in 12 of the remaining 14 patients. Standard of care violations were identified in 10 of 41 true rupture cases.


CONCLUSIONS
Epidemiological data on uterine rupture based on hospital discharge codes without concurrent chart review may be invalid. Patients with previous cesareans represent only half of true uterine ruptures in contemporary practice.
Porreco
Richard P
RP
Presbyterian/St. Luke's Medical Center, Denver, CO, USA.
Clark
Steven L
SL
Belfort
Michael A
MA
Dildy
Gary A
GA
Meyers
Janet A
JA
D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008499:Medical Records; D016595:Misoprostol / Q000627:therapeutic use; D009774:Obstetrics / Q000592:standards / Q000706:statistics & numerical data*; D010120:Oxytocics / Q000627:therapeutic use; D018024:Peer Review, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011453:Prostaglandins / Q000627:therapeutic use; D011785:Quality Assurance, Health Care; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014597:Uterine Rupture / Q000453:epidemiology*; D014599:Uterus / Q000601:surgery*
D010120:Oxytocics; D011453:Prostaglandins; D016595:Misoprostol