Medline ® Abstracts for References 1-4
of 'Rupture of the unscarred uterus'
Maternal and fetal morbidity associated with uterine rupture of the unscarred uterus.
Gibbins KJ, Weber T, Holmgren CM, Porter TF, Varner MW, Manuck TA
Am J Obstet Gynecol. 2015;213(3):382.e1.
OBJECTIVE: We sought to report obstetric and neonatal characteristics and outcomes following primary uterine rupture in a large contemporary obstetric cohort and to compare outcomes between those with primary uterine rupture vs those with uterine rupture of a scarred uterus.
STUDY DESIGN: This was a retrospective case-control study. Cases were defined as women with uterine rupture of an unscarred uterus. Controls were women with uterine rupture of a scarred uterus. Demographics, labor characteristics, and obstetric, maternal, and neonatal outcomes were compared. Primary rupture case outcomes were also compared by mode of delivery.
RESULTS: There were 126 controls and 20 primary uterine rupture cases. Primary uterine rupture cases had more previous live births than controls (3.6 vs 1.9; P<.001). Cases were more likely to have received oxytocin augmentation (80% vs 37%; P<.001). Vaginal delivery was more common among cases (45% vs 9%;P<.001). Composite maternal morbidity was higher among primary uterine rupture mothers (65% vs 20%; P<.001). Cases had a higher mean estimated blood loss (2644 vs 981 mL; P<.001) and higher rate of blood transfusion (68% vs 17%; P<.001). Women with primary uterine rupture were more likely to undergo hysterectomy (35% vs 2.4%; P<.001). Rates of major composite adverse neonatal neurologic outcomes including intraventricular hemorrhage, periventricular leukomalacia, seizures, and death were higher in cases (40% vs 12%; P = .001). Primary uterine rupture cases delivering vaginally were more likely to ultimately undergo hysterectomy than those delivering by cesarean (63% vs 9%; P = .017).
CONCLUSION: Although rare, primary uterine rupture is particularly morbid. Clinicians must remain vigilant, particularly in the setting of heavy vaginal bleeding and severe pain.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT; Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT. Electronic address: Karen.firstname.lastname@example.org.
Third-trimester uterine rupture without previous cesarean: a case series and review of the literature.
Dow M, Wax JR, Pinette MG, Blackstone J, Cartin A
Am J Perinatol. 2009;26(10):739.
We sought to describe a case series and literature review of uterine rupture in the absence of a previous cesarean delivery. In addition to four cases in our institution, a search of the literature from 1994 to 2008 identified cases of uterine rupture unrelated to a prior cesarean. Uterine rupture in the absence of a previous cesarean may be associated with remote unrecognized uterine perforation, myomectomy, thermal injury, and obstructed labor. Such ruptures may occur before or after labor onset, at term or preterm, and with or without nonreassuring fetal heart rate patterns. Spontaneous uterine rupture is associated with highly variable and nonspecific maternal complaints and fetal status, requiring a high index of diagnostic suspicion.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine, USA.
The changing specter of uterine rupture.
Porreco RP, Clark SL, Belfort MA, Dildy GA, Meyers JA
Am J Obstet Gynecol. 2009;200(3):269.e1. Epub 2009 Jan 10.
OBJECTIVE: The objective of the study was to review all patient records discharged with codes for uterine rupture in 2006 in Hospital Corporation of America hospitals.
STUDY DESIGN: All patient charts were distributed to a committee of perinatologists and general obstetricians. Case report forms were analyzed for variables of interest to determine validity of coding and quality of care.
RESULTS: Of 69 cases identified, only 41 were true ruptures. Twenty patients had previous cesareans, and in 9 of these patients, concurrent use of oxytocics was documented. Among the 21 patients without previous cesareans, 7 had previous uterine surgery, and oxytocics were documented in 12 of the remaining 14 patients. Standard of care violations were identified in 10 of 41 true rupture cases.
CONCLUSION: Epidemiological data on uterine rupture based on hospital discharge codes without concurrent chart review may be invalid. Patients with previous cesareans represent only half of true uterine ruptures in contemporary practice.
Presbyterian/St. Luke's Medical Center, Denver, CO, USA.
Intrapartum rupture of the unscarred uterus.
Miller DA, Goodwin TM, Gherman RB, Paul RH
Obstet Gynecol. 1997;89(5 Pt 1):671.
OBJECTIVE: To examine risk factors and maternal and neonatal outcomes in ten cases of intrapartum rupture of the unscarred uterus.
METHODS: Uterine ruptures in women without previous cesarean deliveries were identified from an ongoing log for a 12-year period beginning January 1, 1983. Detailed information was obtained by review of hospital records.
RESULTS: From January 1, 1983, through December 31, 1994, we identified 13 uterine ruptures in women without previous cesarean deliveries. Three resulted from motor vehicle accidents and were excluded from analysis. Ten occurred during labor and are the subjects of our report. The incidence of intrapartum rupture of an unscarred uterus was 1 in 16,849 deliveries. Associated factors included oxytocin use (four cases), prostaglandin use (three cases), use of vacuum or forceps (three cases), grand multiparity (two cases), and malpresentation (two cases). Intervention was prompted by fetal heart rate decelerations in seven cases and by severe hemorrhage in three. Uterine rupture was associated with acute abdominal pain in six cases, maternal tachycardia in five, and severe hypotension in two. Neonatal outcomes were normal in nine cases. There wereno maternal or perinatal deaths.
CONCLUSION: Intrapartum rupture of the unscarred uterus is a rare obstetric emergency. Maternal and perinatal outcomes are optimized by awareness of risk factors, recognition of clinical signs and symptoms, and prompt surgical intervention.
LAC + USC Women's and Children's Hospital, Department of Obstetrics and Gynecology, USA.