title: Maternal and fetal signs and symptoms associated with uterine rupture in women with prior cesarean delivery.
abstract: OBJECTIVE
  To describe the association between maternal and fetal physical signs and symptoms (signs/symptoms) and childbirth outcomes in women with prior cesarean delivery (CD).
  
  
  METHODS
  Cases of uterine rupture at a single institution were reviewed to examine risk factors for experiencing signs/symptoms and poor childbirth outcomes.
  
  
  RESULTS
  Among 21 014 deliveries, 3252 (15.5%) had prior CD, and 75 (2.3%) had uterine rupture. Of these, 66 (88.0%) labored. Among those who labored, 51 (77.3%) demonstrated signs/symptoms prior to delivery. Signs/symptoms included vaginal bleeding, abdominal pain, fetal bradycardia and decreased fetal heart rate (FHR) variability. Laboring patients with signs/symptoms were seven times more likely than those without them to have poor maternal/neonatal outcome (27/51 [52.9%] versus 2/15 [13.3%], OR = 7.31 [95% CI 1.34-52.43], p = 0.0155). In multivariate analysis, risk factors for poor fetal outcome were cervical ripening (OR 4.99 [95% CI 0.86-28.99, p = 0.0735) and prolonged FHR deceleration/bradycardia (OR 2.78 [95% CI 0.86-9.10], p = 0.0905). Fetal tachycardia was a risk factor for poor maternal outcome (OR 8.10 [95% CI 1.40-46.84], p = 0.0195).
  
  
  CONCLUSIONS
  Among laboring women with uterine rupture, 77% demonstrated maternal or fetal signs/symptoms before delivery. The presence of at least one sign/symptom identified nearly all laboring patients (27/29 [93.1%]) with poor outcomes.
authors.affiliation: a Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine , LAC + USC Medical Center, Keck School of Medicine, University of Southern California , Los Angeles , CA , USA.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Ouzounian
authors.affiliation: a Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine , LAC + USC Medical Center, Keck School of Medicine, University of Southern California , Los Angeles , CA , USA.
authors.forename: Johanna
authors.initials: J
authors.lastname: Quist-Nelson
authors.affiliation: a Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine , LAC + USC Medical Center, Keck School of Medicine, University of Southern California , Los Angeles , CA , USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Miller
authors.affiliation: a Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine , LAC + USC Medical Center, Keck School of Medicine, University of Southern California , Los Angeles , CA , USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Korst
keywords: Childbirth morbidity; fetal tachycardia; silent uterine rupture; uterine rupture classification; uterine rupture documentation