title: Uterine rupture in The Netherlands: a nationwide population-based cohort study.
abstract: OBJECTIVE
  To assess incidence of uterine rupture in scarred and unscarred uteri and its maternal and fetal complications in a nationwide design.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  All 98 maternity units in The Netherlands.
  
  
  METHODS
  All women delivering in The Netherlands between August 2004 and August 2006 (n = 371,021).
  
  
  METHODS
  Women with uterine rupture were prospectively collected using a web-based notification system. Data from all pregnant women in The Netherlands during the study period were obtained from Dutch population-based registers. Results were stratified by uterine scar.
  
  
  METHODS
  Population-based incidences, severe maternal and neonatal morbidity and mortality, relative and absolute risk estimates.
  
  
  RESULTS
  There were 210 cases of uterine rupture (5.9 per 10,000 pregnancies). Of these women, 183 (87.1%) had a uterine scar, incidences being 5.1 and 0.8 per 10,000 in women with and without uterine scar. No maternal deaths and 18 cases of perinatal death (8.7%) occurred. The overall absolute risk of uterine rupture was 1 in 1709. In univariate analysis, women with a prior caesarean, epidural anaesthesia, induction of labour (irrespective of agents used), pre- or post-term pregnancy, overweight, non-Western ethnic background and advanced age had an elevated risk of uterine rupture. The overall relative risk of induction of labour was 3.6 (95% confidence interval 2.7-4.8).
  
  
  CONCLUSIONS
  The population-based incidence of uterine rupture in The Netherlands is comparable with other Western countries. Although much attention is paid to scar rupture associated with uterotonic agents, 13% of ruptures occurred in unscarred uteri and 72% occurred during spontaneous labour.
authors.affiliation: Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands. j.j.zwart@lumc.nl
authors.forename: J J
authors.initials: JJ
authors.lastname: Zwart
authors.forename: J M
authors.initials: JM
authors.lastname: Richters
authors.forename: F
authors.initials: F
authors.lastname: Ory
authors.forename: J I P
authors.initials: JI
authors.lastname: de Vries
authors.forename: K W M
authors.initials: KW
authors.lastname: Bloemenkamp
authors.forename: J
authors.initials: J
authors.lastname: van Roosmalen
mesh_terms: D000328:Adult; D002921:Cicatrix / Q000150:complications; D036861:Delivery, Obstetric / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D014219:Trial of Labor; D014597:Uterine Rupture / Q000453:epidemiology*; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data; D055815:Young Adult