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.
| Original language | English |
|---|---|
| Pages (from-to) | 370-381 |
| Number of pages | 12 |
| Journal | BJOG : An International Journal of Obstetrics and Gynaecology |
| Volume | 126 |
| Issue number | 3 |
| Early online date | 13 Jun 2018 |
| DOIs | |
| Publication status | Published - 1 Feb 2019 |
Funding
There was no funding for this study. Austria: We would like to acknowledge all obstetricians in Austria who reported the cases to AuOSS. Part of the study was sponsored by the Anniversary Fund of the Österreichische Nationalbank – ÖNB. Belgium: We would like to acknowledge all the B.OSS reporting clinicians who contributed data to the study; Marlies De Blaere and Virginie Van Leeuw who contributed to the acquisition of Belgian data; Yvon Englert, Myriam Hanssens, Hans Verstraelen who contributed to the design of the study and interpretation of data. B.OSS is funded by the College for Mother and Newborn, a consultative body of the Belgian Public Health Service. GV was funded by the Flemish Research Foundation (FWO) (2015–2016). Denmark: We would like to acknowledge all the NOSS reporting clinicians who contributed data to the study and Lone Krebs from the Danish NOSS organisation. Finland: We would like to acknowledge Maija Jakobsson, Anna-Maija Tapper, Outi Palomäki, Kati Ojala, Nanneli Pallasmaa and Maija-Riitta Ordén from the Finnish NOSS group. France: We would like to acknowledge all the EPIMOMS obstetricians, midwives and anaesthetists who contributed to case identification and documentation in their hospital, and research assistants who collected the data, as well as members of the Epimoms Study Group. Germany: Sponsored by Qualitätsinitiative – Niedersächsischer Verein zur Förderung der Qualität im Gesundheitswesen e.V. until 2016. Now GerOSS is financed by the Centre for Quality and Management in Health Care, Medical Association of Lower Saxony. The Netherlands: NethOSS board: Jos van Roosmalen, Thomas van den Akker, Kitty Bloemenkamp, Timme Schaap and Joost Zwart. We would like to acknowledge all clinicians reporting data to the LEMMoN study between 2004 and 2006. Sweden: We would like to acknowledge all the NOSS reporting clinicians who contributed data to the study and and Karin Gottvall and Karin Källen at the Medical Birth Registry. United Kingdom: We would like to acknowledge all the UKOSS reporting clinicians who contributed data to the study. Austria: We would like to acknowledge all obstetricians in Austria who reported the cases to AuOSS. Part of the study was sponsored by the Anniversary Fund of the Osterre-€ ichische Nationalbank – ONB.€ Belgium: We would like to acknowledge all the B.OSS reporting clinicians who contributed data to the study; Marlies De Blaere and Virginie Van Leeuw who contributed to the acquisition of Belgian data; Yvon Englert, Myriam Hanssens, Hans Verstraelen who contributed to the design of the study and interpretation of data. B.OSS is funded by the College for Mother and Newborn, a consultative body of the Belgian Public Health Service. GV was funded by the Flemish Research Foundation (FWO) (2015–2016).
| Funders | Funder number |
|---|---|
| Fonds Wetenschappelijk Onderzoek | |
| € ichische Nationalbank | |
| Belgian Public Health Service | |
| UK Research and Innovation | MR/K501256/1 |
UN SDGs
This output contributes to the following UN Sustainable Development Goals (SDGs)
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SDG 3 Good Health and Well-being
Keywords
- Caesarean section
- population-based
- severe maternal morbidity
- trial of labour after caesarean section
- uterine rupture
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