Abstract
Limited data is available to assess the burden of maternal morbidity, mortality, and perinatal outcome after subsequent pregnancy in women with prior uterine rupture. Therefore, this retrospective descriptive study was conducted to determine subsequent pregnancy outcomes in a larger series of women with prior complete uterine rupture. All pregnant women who had complete uterine rupture were managed according to the standard Institute protocol. The women who conceived following a uterine repair from July 2011 to June 2020 were recruited into the study. Outcome measures included severe maternal morbidities and perinatal outcomes. Fifty-three women with prior complete uterine rupture were conceived subsequently. Two women had an abortion in the first and second trimester, respectively. None of the women developed recurrence of uterine rupture. However, three women developed uterine dehiscence in a total of 16 women who went into spontaneous labour before elective cesarean delivery at 32, 36, and 37 weeks, respectively. None of the women had placenta previa, placenta accreta, bowel injury, bladder injury and none required a hysterectomy. However, 16.7% of women needed a blood transfusion. None of the women required mechanical ventilation, inotropic support, and intensive care unit stay. Seventeen babies required neonatal intensive care admission, and prematurity (90%) was the most common reason, followed by low APGAR scores. In conclusion, subsequent pregnancy outcomes in women with prior uterine rupture appear acceptable in institutionalized care. Timing of cesarean delivery may have to be weighed against the risk of prematurity-associated neonatal morbidity and mortality.
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Data available with corresponding author and can be provided upon reasonable request.
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References
Murphy DJ. Uterine rupture. Curr Opin Obstet Gynecol. 2006;18(2):135–40.
Turner MJ. Uterine rupture. Best Pract Res Clin Obstet Gynaecol. 2002;16:6979.
Tanos V, Toney ZA. Uterine scar rupture - Prediction, prevention, diagnosis, and management. Best Pract Res Clin Obstet Gynaecol. 2019;59:115–31.
Landon MB, Hauth JC, Leveno KJ, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004;351:25819.
Eze JN, Anozie OB, Lawani OL, Ndukwe EO, Agwu UM, Obuna JA. Evaluation of obstetricians' surgical decision making in the management of uterine rupture. BMC Pregnancy Childbirth. 2017;17(1):179.
Walsh C, Baxi L. Rupture of the primigravid uterus: A review of the literature. Obstet Gynecol Surv. 2007;62(5):327–34.
Usta IM, Hamdi MA, Musa AA, Nassar AH. Pregnancy outcome in patients with previous uterine rupture. Acta Obstet Gynecol Scand. 2007;86:172–6.
Fox NS, Gerber RS, Mourad M, et al. Pregnancy outcomes in patients with prior uterine rupture or dehiscence. Obstet Gynecol. 2014;123:785–9.
Peker N, Aydın E, Evsen MS, et al. Unscarred uterine rupture, and subsequent pregnancy outcome - a tertiary centre experience. Ginekol Pol. 2020;91(2):95–0.
Fox NS, Gerber RS, Mourad M, et al. Pregnancy outcomes in patients with prior uterine rupture or dehiscence. Obstet Gynecol. 2014;123(4):785–9.
Al Qahtani NH, Al HF. Pregnancy outcome and fertility after complete uterine rupture: a report of 20 pregnancies and a review of literature. Arch Gynecol Obstet. 2011;284(5):1123–6.
Chibber R, El-Saleh E, Al Fadhli R, Al Jassar W, Al Harmi J. Uterine rupture, and subsequent pregnancy outcome--how safe is it? A 25-year study. J Matern Fetal Neonatal Med. 2010;23(5):421-424.
Delecour L, Rudigoz RC, Dubernard G, Huissoud C. Pregnancy, and delivery after complete uterine rupture. J Gynecol Obstet Hum Reprod. 2018;47(1):23–8.
Qureshi B, Inafuku K, Oshima K, Masamoto H, Kanazawa K. Ultrasonographic evaluation of lower uterine segment to predict the integrity and quality of cesarean scar during pregnancy: a prospective study. Tohoku J Exp Med. 1997;183(1):55–65.
Lim AC, Kwee A, Bruinse HW. Pregnancy after uterine rupture: a report of 5 cases and a review of the literature. Obstet Gynecol Surv. 2005;60:613–7.
O’Connor RA, Gaughan B. Pregnancy following simple repair of the ruptured gravid uterus. Br J Obstet Gynaecol. 1989;96:9424.
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N Jha: Helped in conceptualization, design, execution, extraction of data, interpretation, statistical analysis and preparation of final draft of manuscript.
MS Madhuri: Helped in conceptualization, design, execution, extraction of data, interpretation of result and preparation of final draft of manuscript.
AK Jha: Helped in conceptualization, design, execution, extraction of data, interpretation of result and preparation of final draft of manuscript.
NS Kubera: Helped in conceptualization, design, execution, extraction of data and preparation of final draft of manuscript.
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The study was approved by Institute Ethics Committee JIPMER, Puducherry, India (JIP/IEC/2020/255 dated 02/11/2020).
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Jha, N., Madhuri, M.S., Jha, A.K. et al. Subsequent Pregnancy Outcome in Women with Prior Complete Uterine Rupture: A Single Tertiary Care Centre Experience. Reprod. Sci. 29, 1506–1512 (2022). https://doi.org/10.1007/s43032-022-00906-1
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DOI: https://doi.org/10.1007/s43032-022-00906-1