[Uterine rupture: risk factors, maternal and perinatal complications].
OBJECTIVE
To determine risk factors, maternal and perinatal morbidity and mortality associated with uterine rupture in women with previous caesarean delivery.


METHODS
We conducted a population-based, retrospective cohort analysis, comparing deliveries with and without uterine rupture in women with uterine scar during a 12-year period. Women attempting a trial of labour were selected with precise criterion. We analysed obstetric history, characteristics of labour, mode of delivery, maternal and perinatal complications.


RESULTS
Thirty-six uterine ruptures were registered of which 11 were complete. These complete ruptures occurred at a rate of 0.4% among deliveries in women with previous caesarean delivery (n=2718) and 0.5% among women attempting a trial of labour (8/1440). Twenty-one ruptures (58%) were diagnosed during a trial of labour. Some risks factors were identified like a labor after 41weeks of amenorrhea and no medical history of natural childbirth. There were neither maternal nor neonatal deaths. The major maternal complications were postpartum haemorrhage (13.8%, n=5) and blood transfusion (8.3%, n=3), significantly most frequent than in the control group (p<0.01). No hysterectomy was required. Concerning neonatal morbidity, mean lactate rate was significantly higher for the rupture group.


CONCLUSIONS
The low rate of uterine rupture, maternal and neonatal complications supports a rigorously selection of women attemping a trial of labor. A labor after 41weeks of amenorrhea and no medical history of natural childbirth should be added to common criterion.
Guyot
A
A
Service de gynécologie-obstétrique, hôpital Jean-Verdier, AP-HP, université Paris-XIII, avenue du 14 juillet, 93143 Bondy cedex, France.
Carbonnel
M
M
Frey
C
C
Pharisien
I
I
Uzan
M
M
Carbillon
L
L
D000328:Adult; D001034:Apgar Score; D001720:Birth Injuries / Q000097:blood / Q000453:epidemiology; D001803:Blood Transfusion; D002585:Cesarean Section; D002921:Cicatrix; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D019344:Lactic Acid / Q000097:blood; D009321:Natural Childbirth / Q000706:statistics & numerical data; D006473:Postpartum Hemorrhage / Q000209:etiology; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014219:Trial of Labor; D014597:Uterine Rupture / Q000453:epidemiology*; D014599:Uterus / Q000473:pathology
D019344:Lactic Acid