Laparoscopic uterine surgery as a risk factor for uterine rupture during pregnancy

AbstractPurpose:Uterine rupture is a rare but serious event with a median incidence of 0.09%. Previous uterine surgery is the most common risk factor. The aim of our study was to analyze retrospectively women with uterine rupture during labor and to evaluate postulated risk factors such as uterine fundal pressure (UFP).Methods:Twenty thousand one hundred and fifty-two deliveries were analyzed retrospectively. Inclusion criteria were 22 weeks and 0 days–42 weeks and 0 days of gestation, singleton pregnancy and cephalic presentation. Women with primary cesarean section were excluded. A logistic regression analysis adjusting for possible risk factors was conducted and a subgroup analysis of women with unscarred uterus was performed.Results:Twenty-eight cases of uterine rupture were identified (incidence: 0.14%). Uterine rupture was noticed in multipara patients only. In the multivariate analysis among all study patients, only previous cesarean section remained a statistically significant risk factor [adjusted odds ration (adj. OR) 12.52 confidence interval (CI) 95% 5.21–30.09]. In the subgroup analysis among women with unscarred uterus (n=19,415) three risk factors were associated with uterine rupture: UFP (adj. OR 5.22 CI 95% 1.07–25.55), abnormal placentation (adj. OR 20.82 CI 95% 2.48–175.16) and age at delivery >40 years (adj. OR 4.77 CI 95% 1.44–15.85).Conclusions:The main risk factor for uterine rupture in the whole study population is previous uterine surgery. Risk factors in women with unscarred uterus were UFP, abnormal placentation, and age at delivery >40 years. The only factor which can be modified is UFP. We suggest that UFP should be used with caution at least in presence of other supposed risk factors.

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Intestinal adhesion due to previous uterine surgery as a risk factor for delayed diagnosis of uterine rupture: a case report

Journal of Medical Case Reports ◽

10.1186/1752-1947-5-523 ◽

2011 ◽

Vol 5 (1) ◽

Cited By ~ 13

Author(s):

Tomoyuki Kuwata ◽

Shigeki Matsubara ◽

Rie Usui ◽

Shin-ichiro Uchida ◽

Naohiro Sata ◽

...

Keyword(s):

Risk Factor ◽

Case Report ◽

Uterine Rupture ◽

Delayed Diagnosis ◽

Uterine Surgery ◽

Intestinal Adhesion

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Uterine rupture and epidural analgesia: a spurious risk factor?

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/j.1471-0528.2009.02481.x ◽

2010 ◽

Vol 117 (4) ◽

pp. 501-502 ◽

Cited By ~ 2

Author(s):

F Reynolds ◽

G O’Sullivan

Keyword(s):

Risk Factor ◽

Epidural Analgesia ◽

Uterine Rupture

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Is Prior Uterine Surgery a Risk Factor for Adenomyosis?

Obstetrics and Gynecology ◽

10.1097/01.aog.0000143264.59822.73 ◽

2004 ◽

Vol 104 (5, Part 1) ◽

pp. 1034-1038 ◽

Cited By ~ 42

Author(s):

Uma R. Panganamamula ◽

Ozgur H. Harmanli ◽

Ebru F. Isik-Akbay ◽

Chad A. Grotegut ◽

Vani Dandolu ◽

...

Keyword(s):

Risk Factor ◽

Uterine Surgery

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Uterine Rupture - Risk Factors and Pregnancy Outcome in Bundelkhand Region

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/403 ◽

2021 ◽

Vol 10 (27) ◽

pp. 1961-1965

Author(s):

Sheela Jain

Keyword(s):

Risk Factors ◽

Uterine Rupture ◽

Fetal Mortality ◽

Mortality And Morbidity ◽

Factors Associated ◽

Uterine Surgery ◽

Grand Multiparity ◽

Uterine Scar ◽

Congenital Uterine Anomaly ◽

Inter Pregnancy Interval

BACKGROUND Uterine rupture is defined as the tearing of the muscular wall of the uterus during pregnancy or labour.1 Often it occurs from the tearing of previous caesarean scar during labour.2 The other known risk factors for uterine rupture include, maternal age, height, body mass index (BMI), education, birth weight, gestational age, induction of labour, instrumental vaginal delivery, interpregnancy interval, congenital uterine anomaly, grand multiparity, previous uterine surgery, fetal macrosomia, fetal malposition, obstructed labour, uterine instrumentation, attempted forceps delivery, external version, and uterine trauma. 2-6This study was done to find out the prevailing risk factors associated with this grave condition in Bundelkhand region, so that mortality and morbidity associated with it could be prevented. METHODS We have studied 37 cases of uterine rupture, operated in our institution from Jan. 2018 to Oct. 2019. During this period a total of 2986 Caesarean sections (CS) were performed. Of these 37 cases, 5 were Nullipara (13.51 %), 16 primipara (31.25 %) and 16 were grand multipara (31.25 %). 24 cases (64.86 %) had previous uterine scar while 13 (35.13 %) had no scar. RESULTS In our study major risk factors for uterine rupture were found to be previous scars (64.68 %). Obstructive labour (23.07 %), malpresentation (7.69 %), grand multiparity (38.46 %) and prolong labour (30.76 %), were responsible for rupture in unscarred uterus. In all cases we first tried to repair the tear and only 9 (24.32 %) needed hysterectomy. In our study 28 patients (75.67 %) required only repair whereas 24.32 % cases needed hysterectomy. Maternal death was just 1 case (2.7 %) and (51.35 %) babies survived. CONCLUSIONS Majority of uterine rupture cases were found in women who had previous CS. So, first CS should be performed after very careful understanding of its indications. 2.7 % maternal mortality and 51.35 % delivery of live birth babies in our study proves that early detection and proper managing of the case can reduce maternal and fetal mortality in uterine rupture cases. KEY WORDS Uterine Rupture, Previous Scar, Inter-Pregnancy Interval

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Review of uterine rupture at Paropakar Maternity and Women’s Hospital

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v13i1.21612 ◽

2018 ◽

Vol 13 (1) ◽

pp. 23-25 ◽

Cited By ~ 1

Author(s):

Iccha Uprety ◽

Gehanath Baral ◽

Shreena Shrestha

Keyword(s):

Risk Factor ◽

Uterine Rupture ◽

Descriptive Study ◽

Patient Record ◽

Scarred Uterus ◽

Ruptured Uterus

Aims: To determine the case profile of uterine rupture.Methods: Retrospective descriptive study from in-patient record file during two years period.Results: Incidence of uterine rupture recorded was 72 per hundred thousand deliveries (1 in 1390), 25% had ruptured uterus antepartum and 60.7% had live baby.Conclusions: Scarred uterus was the commonest risk factor for rupture uterus and antepartum rupture is not uncommon.

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Uterine rupture and epidural analgesia: a spurious risk factor?

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/j.1471-0528.2009.02482.x ◽

2010 ◽

Vol 117 (4) ◽

pp. 502-502

Author(s):

JJ Zwart ◽

J van Roosmalen

Keyword(s):

Risk Factor ◽

Epidural Analgesia ◽

Uterine Rupture

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Uterine Rupture at 18 Weeks in a Short Interval Pregnancy Following Uterine Surgery

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2021.09.443 ◽

2021 ◽

Vol 28 (11) ◽

pp. S57

Author(s):

CH Waters ◽

CI Echeazu ◽

EG Crihfield ◽

JA Sternchos

Keyword(s):

Uterine Rupture ◽

Short Interval ◽

Uterine Surgery

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Recurrent uterine rupture in third trimester of pregnancy

BMJ Case Reports ◽

10.1136/bcr-2021-241987 ◽

2021 ◽

Vol 14 (8) ◽

pp. e241987

Author(s):

Obiefula Uleanya ◽

Kate McCallin ◽

Noor Khanem ◽

Sabahat Sabir

Keyword(s):

Caesarean Section ◽

Uterine Rupture ◽

Good Condition ◽

Fetal Distress ◽

Uneventful Recovery ◽

Third Trimester ◽

Uterine Surgery ◽

Index Pregnancy ◽

Uterine Malformation ◽

History Of

We report a case of recurrent upper segment uterine rupture in a 31-year-old woman at 32+5/40 weeks of gestation. She had fundal uterine rupture 3 years ago in her first pregnancy at 40 weeks of gestation. There was no history of uterine malformation or prior uterine surgery. However, we noted that she had had three laparoscopic procedures for endometriosis treatment. She was scheduled to have an elective repeat caesarean section at 34+6/40 weeks of gestation in the index pregnancy. Unfortunately, she presented at 32+5/40 weeks with features of acute abdomen and signs of fetal distress. She had a category 1 caesarean section and was found to have fundal uterine rupture at the same site. She had a smooth uneventful recovery following a timely intervention and discharged home on day 5 postoperatively in a good condition with her baby girl.

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