TY - JOUR
T1 - Uterine rupture in The Netherlands: a nationwide population-based cohort study
AU - Zwart, J.J.
AU - Richters, J.M.
AU - Ory, F.
AU - de Vries, J.I.
AU - Bloemenkamp, K.W.
AU - van Roosmalen, J.J.M.
PY - 2009
Y1 - 2009
N2 - Objective: To assess incidence of uterine rupture in scarred and unscarred uteri and its maternal and fetal complications in a nationwide design. Design: Population-based cohort study. Setting: All 98 maternity units in the Netherlands. Population: All women delivering in the Netherlands between August 2004 and August 2006 (n = 371 021). Methods: Women with uterine rupture were prospectively collected using a web-based notification system. Data from all pregnant women in the Netherlands during the study period were obtained from Dutch population-based registers. Results: were stratified by uterine scar. Main outcome measures: Population-based incidences, severe maternal and neonatal morbidity and mortality, relative and absolute risk estimates. Results: There were 210 cases of uterine rupture (5.9 per 10 000 pregnancies). Of these women, 183 (87.1%) had a uterine scar, incidences being 5.1 and 0.8 per 10 000 in women with and without uterine scar. No maternal deaths and 18 cases of perinatal death (8.7%) occurred. The overall absolute risk of uterine rupture was 1 in 1709. In univariate analysis, women with a prior caesarean, epidural anaesthesia, induction of labour (irrespective of agents used), pre- or post-term pregnancy, overweight, non-Western ethnic background and advanced age had an elevated risk of uterine rupture. The overall relative risk of induction of labour was 3.6 (95% confidence interval 2.7-4.8). Conclusion: The population-based incidence of uterine rupture in the Netherlands is comparable with other Western countries. Although much attention is paid to scar rupture associated with uterotonic agents, 13% of ruptures occurred in unscarred uteri and 72% occurred during spontaneous labour. © RCOG 2009 BJOG An International Journal of Obstetrics and Gynaecology.
AB - Objective: To assess incidence of uterine rupture in scarred and unscarred uteri and its maternal and fetal complications in a nationwide design. Design: Population-based cohort study. Setting: All 98 maternity units in the Netherlands. Population: All women delivering in the Netherlands between August 2004 and August 2006 (n = 371 021). Methods: Women with uterine rupture were prospectively collected using a web-based notification system. Data from all pregnant women in the Netherlands during the study period were obtained from Dutch population-based registers. Results: were stratified by uterine scar. Main outcome measures: Population-based incidences, severe maternal and neonatal morbidity and mortality, relative and absolute risk estimates. Results: There were 210 cases of uterine rupture (5.9 per 10 000 pregnancies). Of these women, 183 (87.1%) had a uterine scar, incidences being 5.1 and 0.8 per 10 000 in women with and without uterine scar. No maternal deaths and 18 cases of perinatal death (8.7%) occurred. The overall absolute risk of uterine rupture was 1 in 1709. In univariate analysis, women with a prior caesarean, epidural anaesthesia, induction of labour (irrespective of agents used), pre- or post-term pregnancy, overweight, non-Western ethnic background and advanced age had an elevated risk of uterine rupture. The overall relative risk of induction of labour was 3.6 (95% confidence interval 2.7-4.8). Conclusion: The population-based incidence of uterine rupture in the Netherlands is comparable with other Western countries. Although much attention is paid to scar rupture associated with uterotonic agents, 13% of ruptures occurred in unscarred uteri and 72% occurred during spontaneous labour. © RCOG 2009 BJOG An International Journal of Obstetrics and Gynaecology.
U2 - 10.1111/j.1471-0528.2009.02136.x
DO - 10.1111/j.1471-0528.2009.02136.x
M3 - Article
SN - 1470-0328
VL - 116
SP - 1069
EP - 1078
JO - BJOG: An International Journal of Obstetrics & Gynaecology
JF - BJOG: An International Journal of Obstetrics & Gynaecology
IS - 8
ER -