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Uterine rupture and factors associated with adverse outcomes

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

Abstract

Purpose

To review cases of uterine rupture and identify risk factors associated with adverse outcomes.

Methods

This study is a retrospective cohort of complete uterine ruptures diagnosed in a large hospital system in Massachusetts between 2004 and 2018. Baseline demographics, labor characteristics and outcomes of uterine rupture were collected from medical records.

Results

A total of 173 cases of uterine rupture were identified. There were 30 (17.3%) women with an unscarred uterus, while 142 (82.1%) had a scarred uterus. Adverse outcomes (n = 89, 51.4% of cases) included 26 (15.0%) hysterectomies, 55 (31.8%) blood transfusions, 18 (10.4%) bladder/ureteral injuries, 5 (2.9%) reoperations, 25 (14.5%) Apgar scores lower than 5 at 5 min and 9 (5.2%) perinatal deaths.

Uterine rupture of a scarred uterus was associated with decreased risk of hemorrhage (OR 0.40, 95% CI 0.17–0.93), blood transfusion (OR 0.27, 95% CI 0.11–0.69), hysterectomy (OR 0.23, 95% CI 0.08–0.69) and any adverse outcome (OR 0.34, 95% CI 0.13–0.91) compared with unscarred rupture. Uterine rupture during vaginal delivery was associated with increased risk of transfusion (OR 6.55, 95% CI 1.53–28.05) and hysterectomy (OR 8.95, 95% CI 2.12–37.72) compared with emergent C-section.

Conclusions

Although rare, uterine rupture is associated with adverse outcomes in over half of cases. Unscarred rupture and vaginal delivery demonstrate increased risk of adverse outcomes, highlighting the need for early diagnosis and operative intervention.

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Funding

No funding was obtained for this research.

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Authors and Affiliations

  1. Division of Minimally Invasive Gynecologic Surgery, Brigham and Women’s Hospital, Boston, MA, US

    Stefania K. Finnsdottir, Parmida Maghsoudlou, Kristen Pepin, Xiangmei Gu, Jon I. Einarsson & Sarah L. Cohen Rassier

  2. Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA, US

    Daniela A. Carusi

Authors
  1. Stefania K. Finnsdottir
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  2. Parmida Maghsoudlou
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  3. Kristen Pepin
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  4. Xiangmei Gu
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  5. Daniela A. Carusi
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  6. Jon I. Einarsson
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  7. Sarah L. Cohen Rassier
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Contributions

SKF Finnsdottir: project development, data collection, data analysis, manuscript writing. P Maghsoudlou: data collection, manuscript editing. K Pepin: project development, manuscript editing. X Gu: data analysis. DA Carusi: project development, manuscript editing. JI Einarsson: project development, manuscript editing. SLC Rassier: project development, manuscript editing. SCL Rassier supervised this research. Primary author is SK Finnsdottir. Data collection was done by SK Finnsdottir and P Maghsoudlou. Important decisions regarding study design and analyses were made in collaboration with JI Einarsson, K Pepin and D Carusi. Statistical analysis was done by X Gu. The first draft of the manuscript was written by SK Finnsdottir. All authors are responsible for the content of the submission, participated in the drafting of the manuscript and have approved the final, submitted version.

Corresponding author

Correspondence to Sarah L. Cohen Rassier.

Ethics declarations

Conflict of interest

Dr. Einarsson is a consultant for Hologic, Arthrex and Olympus. The other authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This retrospective study was approved by Partner ‘s Research Management Institutional Review Board according to IRB#: 2019P000065, January 9th 2019.

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Supplementary Information

Below is the link to the electronic supplementary material.

404_2022_6820_MOESM1_ESM.docx

Supplementary file 1: Table S1: Myomectomy details. Table S2: Baseline and delivery characteristics of women with a history of myomectomy

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Finnsdottir, S.K., Maghsoudlou, P., Pepin, K. et al. Uterine rupture and factors associated with adverse outcomes. Arch Gynecol Obstet 308, 1271–1278 (2023). https://doi.org/10.1007/s00404-022-06820-w

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  • DOI: https://doi.org/10.1007/s00404-022-06820-w

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