title: [Clinical study on 67 cases with uterine rupture].
abstract: OBJECTIVE
  To investigate the incidence, etiology, diagnosis, treatment and outcome of uterus rupture.
  
  
  METHODS
  From January 1999 to May 2013, clinical data of 67 cases with uterine rupture in Woman's Hospital, School of Medicine, Zhejiang University were studied retrospectively.
  
  
  RESULTS
  A total of 67 cases of uterine rupture with 21(+2)-39(+2) gestational weeks out of 128 599 deliveries were recorded giving an incidence of uterine rupture was 0.052 1% (67/128 599) . Cesarean scar rupture were found in 59 cases (88%, 59/67) and noncesarean scar rupture were found in 8 cases (12%, 8/67). The causes of uterine rupture include 60 cases of scar uterus (59 cesarean scar cases and 1 myomyectomy scar case), 2 cases of assisted delivery operation trauma, 2 cases of malformed uterus, 3 cases of unknown causes (all with artificial abortion history).Non obstructive dystocia and improper oxytocin use were found to be related with uterine rupture.Fifty-two cases of cesarean scar spontaneous incomplete rupture were found and repaired during repeated cesarean delivery without maternal and fetal complications. The remaining 15 cases need emergency rescue operation for fetal distress or dead fetus, severe acute abdomen, prepartum or postpartum vaginal bleeding even maternal hypovolemia; 6/15 uterine rupture cases were diagnosed with the history, clinical symptoms and signs, 3/15 cases with ultrasonic found dead fetus in the peritoneal cavity before exploratory laparotomy and 6 cases were diagnosed just during laparotomy.Hysterectomy was done in 10/15 cases and uterine repair in 5/15 cases; there was no maternal death and 12 perinatal fetal death (5 cases of mid-late pregnancy termination for deformed fetus) of the 15 uterine rupture cases.One case with hysterectomy was complicated with stress pancreatitis and dysfunction of liver and kidney and discharged 20 days after operation, the remaining 14 cases were discharged 5-7 days postpartum.One case with repaired malformed uterus got pregnancy 4 years later and delivered a 2 000 g healthy baby by cesarean section at gestational age of 33(+4) weeks.
  
  
  CONCLUSIONS
  Uterine scar caused by caesarean section or other operations became the leading cause of uterine rupture, assisted delivery operations, history of intrauterine manipulation and uterine malformations were the predisposing risk factors of uterine rupture.
authors.affiliation: Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China.
authors.forename: Bai
authors.initials: B
authors.lastname: Xiaoxia
authors.affiliation: Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China.
authors.forename: Wang
authors.initials: W
authors.lastname: Zhengping
authors.affiliation: Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China. Email:yangxiaofu@zju.edu.cn.
authors.forename: Yang
authors.initials: Y
authors.lastname: Xiaofu
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects / Q000401:mortality; D002585:Cesarean Section / Q000009:adverse effects*; D002681:China / Q000453:epidemiology; D002921:Cicatrix / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005313:Fetal Death; D005865:Gestational Age; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D015994:Incidence; D007746:Labor Presentation; D008428:Maternal Mortality; D013513:Obstetric Surgical Procedures; D010121:Oxytocin / Q000008:administration & dosage / Q000009:adverse effects*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014597:Uterine Rupture / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000534:rehabilitation
chemical_list: D010121:Oxytocin