title: Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health.
abstract: Caesarean section (CS) is increasing globally, and women with prior CS are at higher risk of uterine rupture in subsequent pregnancies. However, little is known about the incidence, risk factors, and outcomes of uterine rupture in women with prior CS, especially in developing countries. To investigate this, we conducted a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health, which included data on delivery from 359 facilities in 29 countries. The incidence of uterine rupture among women with at least one prior CS was 0.5% (170/37,366), ranging from 0.2% in high-Human Development Index (HDI) countries to 1.0% in low-HDI countries. Factors significantly associated with uterine rupture included giving birth in medium- or low-HDI countries (adjusted odds ratio [AOR] 2.0 and 3.88, respectively), lower maternal educational level (≤6 years) (AOR 1.71), spontaneous onset of labour (AOR 1.62), and gestational age at birth <37 weeks (AOR 3.52). Women with uterine rupture had significantly higher risk of maternal death (AOR 4.45) and perinatal death (AOR 33.34). Women with prior CS, especially in resource-limited settings, are facing higher risk of uterine rupture and subsequent adverse outcomes. Further studies are needed for prevention/management strategies in these settings.
authors.affiliation: Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Motomura
authors.affiliation: Department of Global Health Nursing, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Togoobaatar
authors.initials: T
authors.lastname: Ganchimeg
authors.affiliation: Department of Education for Clinical Research, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Nagata
authors.affiliation: Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan.
authors.forename: Erika
authors.initials: E
authors.lastname: Ota
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Vogel
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Ana Pilar
authors.initials: AP
authors.lastname: Betran
authors.affiliation: Department of Internal Medicine, Evidence Based Healthcare Post-Graduate Programme, São Paulo Federal University, São Paulo, Brazil.
authors.forename: Maria Regina
authors.initials: MR
authors.lastname: Torloni
authors.affiliation: Maternal &Child Morbidity &Mortality Unit, Family Health Bureau, Ministry of Health, Colombo, Sri Lanka.
authors.forename: Kapila
authors.initials: K
authors.lastname: Jayaratne
authors.affiliation: Sora no Mori Clinic, Okinawa, Japan.
authors.forename: Seung Chik
authors.initials: SC
authors.lastname: Jwa
authors.affiliation: Obstetrics &Gynecology, Fortis Memorial Research Institute, Gurgaon, India.
authors.forename: Suneeta
authors.initials: S
authors.lastname: Mittal
authors.affiliation: National Center for Disease Prevention and Control, Department of Health, Manila, Philippines.
authors.forename: Zenaida
authors.initials: Z
authors.lastname: Dy Recidoro
authors.affiliation: Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Matsumoto
authors.affiliation: Department of Pediatrics, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Mikiya
authors.initials: M
authors.lastname: Fujieda
authors.affiliation: Université Abdou Moumouni de Niamey, Niamey, Niger.
authors.forename: Idi
authors.initials: I
authors.lastname: Nafiou
authors.affiliation: American University of Beirut, Beirut, Lebanon.
authors.forename: Khalid
authors.initials: K
authors.lastname: Yunis
authors.affiliation: Obstetrics and Gynaecology, University of Nairobi School of Medicine, Nairobi, Kenya.
authors.forename: Zahida
authors.initials: Z
authors.lastname: Qureshi
authors.affiliation: Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: Joao Paulo
authors.initials: JP
authors.lastname: Souza
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Rintaro
authors.initials: R
authors.lastname: Mori
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014597:Uterine Rupture / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult