Abstract
Background: The goal of this study was to investigate whether pregnancy complications are associated with an increased risk of uterine rupture (UR) and how that risk changes with gestational age. Methods: We obtained all data from China’s National Maternal Near Miss Surveillance System (NMNMSS) between 2012 and 2018. Poisson regression analysis was used to assess the risk of UR with pregnancy complications (preeclampsia, gestational diabetes mellitus, placental abruption, placenta previa and placenta percreta) among 9,454,239 pregnant women. Furthermore, we analysed the risks of UR with pregnancy complications in different gestational age groups. Results: Compared with women without pregnancy complications, those with different complications (except for preeclampsia) had a 1- to 3-fold greater risk of UR. These associations also persisted in women without a previous caesarean delivery. Moreover, an increased risk of UR before term birth was observed among women with gestational diabetes mellitus, placental abruption and placenta percreta. A large for gestational age (LGA) foetus increased the risk of UR in women with gestational diabetes mellitus, especially at 32 to 36 weeks gestation. Conclusions: Better quality antenatal care and early intervention for women with these pregnancy complications are needed to minimize the incidence of UR.