Clinical characteristics of uterine rupture without previous Cesarean section: A 25-year retrospective study

Analysis of the uterine rupture during pregnancy and delivery in a provincial maternal and children care hospital in China: 2013-2022

BACKGROUND

Uterine rupture is rare and life-threatening for both mothers and newborns. This study aimed to explore the clinical manifestation, site of rupture, obstetric risk factors, maternal and neonatal complications, and birth outcomes with mid-trimester and late-pregnancy uterine rupture.

METHODS

Data from patients with uterine rupture occurring at Hunan Maternal and Child Health Hospital between January 2013 and December 2022 were reviewed retrospectively.

RESULTS

153,722 deliveries occurred during the 10 years of the study period. A total number of 129 uterine ruptures were identified: 12 ruptures occurred in the second trimester and 117 cases of uterine rupture diagnosed at or after 28 weeks gestation. The total incidence was 8.4/10,000. Most of the patients had a history of cesarean section (73.6%). 59.7% cases had a history of dilation and curettage. The rupture was more likely to occur on the lower uterine segment (86.82%). Seventy-one patients (55%) presented with abdominal pain or vaginal bleeding. Twenty-seven (20.9%) cases underwent a labor trial. There were 17 perinatal deaths associated with uterine rupture and neonatal asphyxia was observed in five infants. There was one maternal death. Postpartum hemorrhage occurred in 25 cases. Five patients underwent hysterectomy. Patients with uterine rupture during mid-trimester were more likely to receive a blood transfusion and exhibited higher rates of bladder injury.

CONCLUSION

Uterine rupture especially mid-gestational uterine rupture is rare and remains a diagnostic challenge. Remarkably worse maternal outcomes were seen in patients with second-trimester rupture when compared with patients who experienced late-pregnancy rupture. Pregnant women with a history of uterine surgery, even at an early gestational age, should be closely monitored by obstetricians for the risk of uterine rupture if they experience persistent abdominal pain. Early recognition and prompt intervention are key to improve maternal and child outcomes.

Establishing a Multifaceted Comprehensive Maternity Cohort Facilitates Understanding of How Environmental Exposures Impact Perinatal Health

China's "three-child policy", implemented in response to population aging, has made the protection of maternal and infant health an urgent priority. In this environmental and medical big-data era, the Zhejiang Environmental and Birth Health Research Alliance (ZEBRA) maternity cohort was established with the aim of identifying risk factors for perinatal morbidity and mortality from the perspectives of both observational epidemiology and experimental etiology. Compared with conventional birth cohorts, the inclusion of a maternity cohort allows greater scope for research and places an emphasis on maternal health. In particular, it allows us to focus on pregnant women with a history of pregnancy-related illnesses and those planning to have a second or third child. There are currently many pressing issues in perinatal health, including the risk associations between exogenous together with endogenous factors and the occurrence of perinatal abnormalities, pregnancy complications, and adverse pregnancy outcomes. It is crucial to explore the interaction between environmental exposures and genetic factors affecting perinatal health if we are to improve it. It is also worthwhile to assess the feasibility of the early stage prediction of major perinatal abnormalities. We hope to study this in the ZEBRA cohort and also seek nationwide and international collaborations to establish a multicenter cohort consortium, with the ultimate goal of contributing epidemiological evidence to literature and providing evidence-based insights for global maternal and child healthcare.

Uterine rupture in patients with a history of hysteroscopy procedures: Case series and review of literature

RATIONALE

Uterine rupture during pregnancy poses significant risks to both the fetus and the mother, resulting in high mortality and morbidity rates. While awareness of uterine rupture prevention after a cesarean section has increased, insufficient attention has been given to cases caused by pregnancy following hysteroscopy surgery.

PATIENT CONCERNS

We report 2 cases here, both of whom had a history of hysteroscopy surgery and presented with severe abdominal pain during pregnancy.

DIAGNOSES

Both patients had small uterine ruptures, with no significant abnormalities detected on ultrasonography. The diagnosis was confirmed by a CT scan, which showed hemoperitoneum.

INTERVENTIONS

We performed emergency surgeries for the 2 cases.

OUTCOMES

We repaired the uterus in 2 patients during the operation. Both patients recovered well. The children survived. No abnormalities were detected during their follow-up visits.

LESSONS

Attention should be paid to the cases of pregnancy after hysteroscopy.

Impact of myomectomy on the obstetric complications: A large cohort study in Japan

OBJECTIVE

The authors conducted a large-scale cohort study using the Japan Society of Obstetrics and Gynecology's perinatal registry database to determine the effect of myomectomy on perinatal outcomes.

METHODS

This retrospective cohort study enrolled 203 745 women who gave birth between January and December 2020 in Japan. The participants were classified into two groups based on their history of myomectomy (open/laparoscopic) to investigate fertility treatment, delivery information, obstetric complications, maternal treatment, infant information, fetal appendages, obstetric history, underlying disease, infectious disease, drugs used, and case information regarding maternal and infant death.

RESULTS

In total, 1161 pregnant women had a history of myomectomy and 202 584 did not. Compared with the nonmyomectomy group, the myomectomy group had a higher occurrence rate of uterine rupture (0.9% vs 0.06%, P < 0.01) and placenta accreta (1.5% vs 0.5%, P < 0.01). In addition, history of myomectomy (odds ratio [OR], 2.62 [95% confidence interval (CI), 1.500-4.226]; P < 0.001) was found to be an independent factor for placenta accrete and uterine rupture (OR, 14.4 [95% CI, 6.75-27.02]; P < 0.001). Furthermore, myomectomy increased the risk of uterine rupture by 14 times.

CONCLUSION

Postmyomectomy pregnancy may increase the risk of placenta accreta and uterine rupture.

Uterine rupture during pregnancy: The URIDA (uterine rupture international data acquisition) study

OBJECTIVE

To describe the characteristics and peripartum outcomes of patients diagnosed with uterine rupture (UR) by an observational cohort retrospective study on 270 patients.

METHODS

Demographic information, surgical history, symptoms, and postoperative outcome of women and neonates after UR were collected in a large database. The statistical analysis searched for correlation between UR, previous uterine interventions, fibroids, and the successive perinatal outcomes in women with previous UR.

RESULTS

Uterine rupture was significantly associated with previous uterine surgery, occurring, on average, at 36 weeks of pregnancy in women also without previous uterine surgery. UR did not rise exponentially with an increasing number of uterine operations. Fibroids were related to UR. The earliest UR occurred at 159 days after hysteroscopic myomectomy, followed by laparoscopic myomectomy (251 days) and laparotomic myomectomy (253 days). Fertility preservation was feasible in several women. Gestational age and birth weight seemed not to be affected in the subsequent pregnancy.

CONCLUSION

Data analysis showed that previous laparoscopic and abdominal myomectomies were associated with UR in pregnancy, and hysteroscopic myomectomy was associated at earlier gestational ages. UR did not increase exponentially with an increasing number of previous scars. UR should not be considered a contraindication to future pregnancies.