Yu-Hsing Chang1. 1. Department of Obstetrics and Gynaecology, Waikato District Health Board, Hamilton, New Zealand.
Abstract
BACKGROUND: Uterine rupture is a rare obstetric emergency, and the rate of rupture has increased over time with the rising rate of caesarean section (CS) and trial of labour after CS (TOLAC). AIM: To determine the prevalence, and maternal and neonatal complications associated with complete uterine rupture at a New Zealand (NZ) tertiary referral hospital over an 11-year period. MATERIAL AND METHODS: This is a retrospective, observational study. Waikato Hospital records of patients with uterine rupture occurring between 2008 and 2018 were reviewed for risk factors, delivery outcomes, and maternal and neonatal complications. RESULTS: There were 32 patients with complete uterine rupture in 38 182 births, conferring a prevalence of 8.4 per 10 000 births (95% CI 5.9-11.8). Of the 29 cases occurring during labour, 83% of patients were multiparous, 59% previously had one or two CS; patients with an unscarred uterus had lower rates of emergency CS and high rates of postpartum haemorrhage than patients with a scarred uterus. There were no maternal deaths although three patients required peripartum hysterectomy, 63% required blood transfusion and there were five (16%) perinatal deaths. CONCLUSION: The prevalence of uterine rupture in this NZ tertiary hospital is comparable to other developed countries. There was no maternal mortality but there was a 16% perinatal death rate. Patients with spontaneous labour and an unscarred uterus were not exempt from this rare complication. There is a need to manage labour judiciously in all patient groups and to maintain a high level of suspicion for uterine rupture.
BACKGROUND: Uterine rupture is a rare obstetric emergency, and the rate of rupture has increased over time with the rising rate of caesarean section (CS) and trial of labour after CS (TOLAC). AIM: To determine the prevalence, and maternal and neonatal complications associated with complete uterine rupture at a New Zealand (NZ) tertiary referral hospital over an 11-year period. MATERIAL AND METHODS: This is a retrospective, observational study. Waikato Hospital records of patients with uterine rupture occurring between 2008 and 2018 were reviewed for risk factors, delivery outcomes, and maternal and neonatal complications. RESULTS: There were 32 patients with complete uterine rupture in 38 182 births, conferring a prevalence of 8.4 per 10 000 births (95% CI 5.9-11.8). Of the 29 cases occurring during labour, 83% of patients were multiparous, 59% previously had one or two CS; patients with an unscarred uterus had lower rates of emergency CS and high rates of postpartum haemorrhage than patients with a scarred uterus. There were no maternal deaths although three patients required peripartum hysterectomy, 63% required blood transfusion and there were five (16%) perinatal deaths. CONCLUSION: The prevalence of uterine rupture in this NZ tertiary hospital is comparable to other developed countries. There was no maternal mortality but there was a 16% perinatal death rate. Patients with spontaneous labour and an unscarred uterus were not exempt from this rare complication. There is a need to manage labour judiciously in all patient groups and to maintain a high level of suspicion for uterine rupture.