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Contemporary epidemiology and novel predictors of uterine rupture: a nationwide population-based study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

In spite of several policies aiming to decrease cesarean rates and related complications such as uterine rupture, data show that uterine rupture and associated morbidity are increasing along the years. Whether previously unidentified risk factors are currently playing an important role on these trends is unknown. We analyze current risks of uterine rupture and main preceding factors from more recent years compared to former data.

Methods

All uterine rupture cases in the US from 2011–2012 were selected, with matched non-uterine rupture cases selected as controls. Variables considered for analysis included demographics, maternal morbidity, and obstetric complications. Likelihood forward selection was used to identify main risk factors of uterine rupture. Medians of main factors identified were used to simulate groups at risk and calculate odds ratios of uterine rupture.

Results

From ~8 million births, 1925 presented uterine rupture. In patients with no prior cesarean delivery, multiple gestation, chronic hypertension and chorioamnionitis presented the highest odds of uterine rupture, with the combination of these factors increasing the odds of rupture 59 times (~1%). In women with prior cesarean delivery, induction/augmentation and chorioamnionitis were the most significant predictors, with the combination increasing the odds 33 times (~3%).

Conclusions

Despite policies implemented and changes in clinical practice, uterine rupture remains an important issue. Previously unidentified risk factors are playing now an important role, information that should be considered during patient counseling and clinical practice. Combinations of some of these factors may increase the risk of uterine rupture significantly enough to modify clinical care.

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, 2310 Holmes St. STE 713, Kansas City, MO, 64108, USA

    Gustavo Vilchez, Sarah Nazeer, Komal Kumar & Morgan Warren

  2. Department of Obstetrics and Gynecology, Wayne State University School of Medicine, 275 E, Hancock, Detroit, MI, 48201, USA

    Jing Dai & Robert J. Sokol

Authors
  1. Gustavo Vilchez
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  2. Sarah Nazeer
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  3. Komal Kumar
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  4. Morgan Warren
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  5. Jing Dai
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  6. Robert J. Sokol
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Contributions

GV: conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing – original draft, writing—review and editing. SN: investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing—review and editing. KK: investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing—review and editing. MW: investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing—review and editing. JD: conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing—original draft, writing—review and editing. RS: conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing—original draft, writing—review and editing.

Corresponding author

Correspondence to Gustavo Vilchez.

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Informed consent

This is a retrospective population-based study of de-identified data so informed consent was not possible/required.

Funding

This study was not funded.

Conflict of interest

The authors report no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Vilchez, G., Nazeer, S., Kumar, K. et al. Contemporary epidemiology and novel predictors of uterine rupture: a nationwide population-based study. Arch Gynecol Obstet 296, 869–875 (2017). https://doi.org/10.1007/s00404-017-4508-4

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  • DOI: https://doi.org/10.1007/s00404-017-4508-4

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