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BJOG. 2019 Feb;126(3):370-381. doi: 10.1111/1471-0528.15271. Epub 2018 Jun 12.

The International Network of Obstetric Survey Systems study of uterine rupture: a descriptive multi-country population-based study.

Author information

1
Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium.
2
Department of Obstetrics and Gynaecology, Birth Centre Wilhelmina's Children Hospital, Devision Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands.
3
Centre for Quality and Management in Health Care, Medical Association of Lower Saxony, Hannover, Germany.
4
Department of Obstetrics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
5
Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Inserm U1153, Paris Descartes University, Paris, France.
6
Information Services Department, THL National Institute for Health and Welfare, Helsinki, Finland.
7
Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden.
8
National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
9
Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
10
Department of Obstetrics and Gynecology, Sodersjukhuset, Stockholm, Sweden.
11
Department of Clinical Epidemiology, Tirol Kliniken Ltd., Innsbruck, Austria.
12
Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.
13
Athena Institute, VU University Amsterdam, Amsterdam, the Netherlands.
14
Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands.
15
Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, the Netherlands.

Abstract

OBJECTIVE:

International comparison of complete uterine rupture.

DESIGN:

Descriptive multi-country population-based study.

SETTING:

International.

POPULATION:

International Network of Obstetric Survey Systems (INOSS).

METHODS:

We merged individual data, collected prospectively in nine population-based studies, of women with complete uterine rupture, defined as complete disruption of the uterine muscle and the uterine serosa, regardless of symptoms and rupture of fetal membranes.

MAIN OUTCOME MEASURES:

Prevalence of complete uterine rupture, regional variation and correlation with rates of caesarean section (CS) and trial of labour after CS (TOLAC). Severe maternal and perinatal morbidity and mortality.

RESULTS:

We identified 864 complete uterine ruptures in 2 625 017 deliveries. Overall prevalence was 3.3 (95% CI 3.1-3.5) per 10 000 deliveries, 22 (95% CI 21-24) in women with and 0.6 (95% CI 0.5-0.7) in women without previous CS. Prevalence in women with previous CS was negatively correlated with previous CS rate (ρ = -0.917) and positively correlated with TOLAC rate of the background population (ρ = 0.600). Uterine rupture resulted in peripartum hysterectomy in 87 of 864 women (10%, 95% CI 8-12%) and in a perinatal death in 116 of 874 infants (13.3%, 95% CI 11.2-15.7) whose mother had uterine rupture. Overall rate of neonatal asphyxia was 28% in neonates who survived.

CONCLUSIONS:

Higher prevalence of complete uterine ruptures per TOLAC was observed in countries with low previous CS and high TOLAC rates. Rates of hysterectomy and perinatal death are about 10% following complete uterine rupture, but in women undergoing TOLAC the rates are extremely low (only 2.2 and 3.2 per 10 000 TOLACs, respectively.) TWEETABLE ABSTRACT: Prevalence of complete uterine rupture is higher in countries with low previous CS and high TOLAC rates.

KEYWORDS:

Caesarean section; population-based; severe maternal morbidity; trial of labour after caesarean section; uterine rupture

PMID:
29727918
DOI:
10.1111/1471-0528.15271
[Indexed for MEDLINE]

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