scholarly journals Symptomatic Uterine Rupture: A Fifteen Year Review

Medicina ◽  
2020 ◽  
Vol 56 (11) ◽  
pp. 574
Author(s):  
Egle Savukyne ◽  
Raimonda Bykovaite-Stankeviciene ◽  
Egle Machtejeviene ◽  
Ruta Nadisauskiene ◽  
Regina Maciuleviciene
Keyword(s):  
Risk Factors ◽  
Abdominal Pain ◽  
Incidence Rate ◽  
Cesarean Delivery ◽  
Epidural Anaesthesia ◽  
Uterine Rupture ◽  
Acute Abdominal Pain ◽  
Significant Risk ◽  
Uterine Scar ◽  
Previous Cesarean

Background and objectives: To assess the incidence of complete and partial uterine rupture during childbirth in a single tertiary referral centre as well as the significant risk factors, symptoms and peripartum complications. Materials and Methods: A retrospective single-centre study involved all cases of uterine rupture at the Kaunas Perinatal Centre in 2004–2019. Data were from a local medical database complemented with written information from medical records. We included 45,893 women with an intact uterus and 5630 with uterine scars. Women (n = 5626) with scarred uterus’ after previous cesarean delivery. The diagnosis was defined by clinical symptoms, leading to an emergency cesarean delivery, when complete or partial uterine rupture (n = 35) was confirmed. Asymptomatic cases, when uterine rupture was found at elective cesarean section (n = 3), were excluded. The control group is represented by all births delivered in our department during the study period (n = 51,525). The outcome was complete (tearing of all uterine wall layers, including serosa and membranes) and partial uterine rupture (uterine muscle defect but intact serosa), common uterine rupture symptoms. Risk factors were parameters related to pregnancy and labour. Results: 51,525 deliveries occurred in Kaunas Perinatal Centre during the 15 years of the study period. A total number of 35 (0.06%) symptomatic uterine ruptures were recorded: 22 complete and 13 partial, leading to an incidence rate of 6.8 per 10,000 deliveries. The uterine rupture incidence rate after a single previous cesarean delivery is 44.4 per 10,000 births. 29 (83%) cases had a uterine scar after previous cesarean, 4 (11%) had a previous laparoscopic myomectomy, 2 (6%) had an unscarred uterus. The most significant risk factors of uterine rupture include uterine scarring and augmentation or epidural anaesthesia in patients with a uterine scar after cesarean delivery. The most common clinical sign was acute abdominal pain in labour 18 (51%). No maternal, six intrapartum perinatal deaths (17%) occurred, and one hysterectomy (2.8%) was performed due to uterine rupture. Neonatal mortality reached 22% among the complete ruptures. Average blood loss was 1415 mL, 4 (11%) patients required blood transfusion. Conclusions: The incidence rate of uterine rupture (complete and incomplete) at Kaunas Perinatal Centre is 6.8 per 10,000 deliveries. In cases with a scar of the uterus after a single cesarean, the incidence of uterine rupture is higher, exceeding 44 cases per 10,000 births. The most significant risk factors were uterine scar and augmentation or epidural anaesthesia in a previous cesarean delivery. Acute abdominal pain in labour is the most frequent symptom for uterine rupture.

scholarly journals Prevalence of urinary tract infection and associated risk factors among women in Sindhupalchowk district, Nepal

2018 ◽  
Vol 5 (7) ◽  
pp. 2714 ◽  
Author(s):  
Leela Paudel ◽  
Naresh Manandhar ◽  
Saroj Sah ◽  
Sudesha Khadka ◽  
Samikshya Neupane ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Tract Infection ◽  
Abdominal Pain ◽  
Urinary Tract ◽  
Tract Infection ◽  
Significant Risk ◽  
Lower Abdominal Pain ◽  
Common Symptom ◽  
High Power Field ◽  
Toilet Facility

Background: Urinary tract infection (UTI) occurs in all age groups, more common in women due to short urethra and its close proximity to anus and vagina. UTI is defined as “microscopic finding of >10 pus cells/high power field (40x) in urine”. The purpose of the study is to find the prevalence of UTI and its association with various risk factors.Methods: An analytical cross-sectional study on prevalence of UTI was done among 260 women aged 15 years and above. Convenient sampling technique was used. Semi-structured questionnaire was designed to collect the data and urine sample was collected for routine and microscopic examination at the time of interview. Collected urine was sent, within 3 hours of collection.Results: The mean age of the respondents was 36.43±16.17 years. The prevalence of UTI among women aged 15 years and above was 36.9%.The most common symptom was frequency of micturition (35%) followed by lower abdominal pain (38.46%). There was significant association between frequency of micturition, burning micturition and lower abdominal pain with occurrence of urinary tract infection. On urinalysis, 96 samples were positive for pus cell; one sample showed blood, 16 samples showed ca-oxalate and 57 samples showed protein which determines the type of UTI. Smoking [COR-2.15, C.I-(1.12, 4.09)] and unavailability of toilet facility [COR-0.27, C.I-(0.08, 0.93)] were the significant risk factors for occurrence of UTI.Conclusions: There was high prevalence of UTI among women aged 15 years and above and association between smoking and unavailability of toilet facility and UTI was significant.

Tumour incidence in Fabry disease: A cross-sectional study

2019 ◽  
Vol 3 (2) ◽  
pp. 80-87
Author(s):  
Federica Rossi ◽  
Sara Auricchio ◽  
Agnese Binaggia ◽  
Vincenzo L’imperio ◽  
Fabio Pagni ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Fabry Disease ◽  
Incidence Rate ◽  
Early Stage ◽  
Treatment Success ◽  
Significant Risk ◽  
Cancer Development ◽  
Cancer Prevalence ◽  
Enzyme Replacement

Background: Recently, a possible correlation between altered glycosphingolipid metabolism, that occurs in Fabry disease, and cancer development has been suggested. We analysed both incidence and prevalence of benign and malignant tumours in a Fabry patient cohort and compared them with the Italian general population. The analysis of major risk factors was performed. Methods: A total of 53 Fabry patients, followed by Nephrology Unit of San Gerardo Hospital (Monza, Italy), were retrospectively enrolled. Primary outcome was cancer development during the follow-up period (2007–2017). Cancer prevalence and incidence rate were calculated and compared to those in the Italian general population, acquired from public report on cancer estimates produced by the Cancer Registers’ Italian Association. Fisher’s exact test and multivariate analysis were performed to identify significant risk factors. Results: Nine (17%) patients were diagnosed with malignant neoplasia (stage T1–T3, N0M0). Most of them were female (77.8%) and were 59 ± 9 years old. In the benign tumour group, different lesions, ranging from adenoma to dysplasia, were recorded. Italian cancer prevalence is currently 5.5%, while in our population it was 17%; the incidence rate ratio of the Fabry population compared with the general population was 2.66 (95% confidence interval from 1.33 to 5.32). The risk factor analysis has revealed that older age was a negative factor for cancer onset, while enzyme replacement therapy had a protective role effect against cancer in Fabry patients. Conclusion: Cancer could be an important associated pathology in Fabry patients. Their altered glycosphingolipid metabolism may have an oncogenic role. Further studies are needed to clarify the relationships between Fabry disease and cancer onset. Tumours in Fabry subjects could be diagnosed at an early stage allowing patients to have a concrete chance of treatment success.

scholarly journals Uterine Rupture - Risk Factors and Pregnancy Outcome in Bundelkhand Region

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

Disparate Rates of Cesarean Delivery in Term Nulliparous Women with Hypertensive Disorders of Pregnancy

2019 ◽  
Vol 36 (10) ◽  
pp. 997-1001 ◽  
Author(s):  
Christina A. Penfield ◽  
Michael P. Nageotte ◽  
Deborah A. Wing
Keyword(s):  
Risk Factors ◽  
Cesarean Delivery ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Target Population ◽  
Vital Statistics ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Important Target ◽  
Nulliparous Women

Objective To evaluate the prevalence of cesarean delivery in women with hypertensive disorders of pregnancy (HDP), and explore whether maternal, sociodemographic, or obstetric comorbidities contribute to cesarean delivery rates. Study Design This is a retrospective cohort study of nulliparous, term, singleton, vertex women using the 2013 U.S. National Vital Statistics Report. We compared prevalence of risk factors for cesarean delivery between women with and without HDP, and then calculated probabilities of cesarean delivery after controlling for these risk factors. Results In this cohort of 1,439,977 women, the unadjusted probability of cesarean delivery in women with HDP was 39.5 versus 26.8% in those without the diagnosis (p < 0.01). Hypertensive women had more risk factors for cesarean delivery, most notably morbid obesity (9.0 vs. 3.1%, p < 0.01), diabetes (9.9 vs. 4.4%, p < 0.01), and induction of labor (59.2 vs. 26.9%, p < 0.01). Despite this, after controlling for these risk factors, hypertensive women remained significantly more likely to undergo cesarean delivery (35.1 vs. 26.4%, p < 0.01). Conclusion Even after controlling for multiple comorbidities, hypertension remained a significant risk factor for cesarean delivery in nulliparous women at term. Hypertensive women may therefore represent an important target population in efforts aimed at reduction of cesarean rates.

scholarly journals Risk factors of uterine rupture with a special interest to uterine fundal pressure

2017 ◽  
Vol 45 (3) ◽  
Author(s):  
Karin Sturzenegger ◽  
Leonhard Schäffer ◽  
Roland Zimmermann ◽  
Christian Haslinger
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cesarean Section ◽  
Subgroup Analysis ◽  
Uterine Rupture ◽  
Significant Risk ◽  
Abnormal Placentation ◽  
Singleton Pregnancy ◽  
Uterine Surgery ◽  
Fundal Pressure

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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