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Mao H, Shen P. Trial of labor versus elective cesarean delivery for patients with two prior cesarean sections: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2024; 37:2326301. [PMID: 38485519 DOI: 10.1080/14767058.2024.2326301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/28/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE Cesarean section (CS) rates have been on the rise globally, leading to an increasing number of women facing the decision between a Trial of Labor after two Cesarean Sections (TOLAC-2) or opting for an Elective Repeat Cesarean Section (ERCS). This study evaluates and compares safety outcomes of TOLAC and ERCS in women with a history of two previous CS deliveries. METHODS PubMed, MEDLINE, EMbase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for studies published until 30 June 2023. Eligible studies were included based on predetermined criteria, and a random-effects model was employed to pool data for maternal and neonatal outcomes. RESULTS Thirteen studies with a combined sample size of 101,011 women who had two prior CS were included. TOLAC-2 was associated with significantly higher maternal mortality (odds ratio (OR)=1.50, 95% confidence interval (CI)= 1.25-1.81) and higher chance of uterine rupture (OR = 7.15, 95% CI = 3.44-14.87) compared to ERCS. However, no correlation was found for other maternal outcomes, including blood transfusion, hysterectomy, or post-partum hemorrhage. Furthermore, neonatal outcomes, such as Apgar scores, NICU admissions, and neonatal mortality, were comparable in the TOLAC-2 and ERCS groups. CONCLUSION Our findings suggest an increased risk of uterine rupture and maternal mortality with TOLAC-2, emphasizing the need for personalized risk assessment and shared decision-making by healthcare professionals. Additional studies are needed to refine our understanding of these outcomes in the context of TOLAC-2.
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Affiliation(s)
- Hui Mao
- Delivery Room on the 2nd Floor of the Inpatient Department, Huzhou Maternity & Child Health Care Hospital, Huzhou City, China
| | - Pinghua Shen
- Delivery Room on the 2nd Floor of the Inpatient Department, Huzhou Maternity & Child Health Care Hospital, Huzhou City, China
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2
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Overtoom EM, Huynh TN, Rosman AN, Zwart JJ, Schaap TP, Vogelvang TE, van den Akker T, Bloemenkamp KWM. Predicting the risks and recognizing the signs: a two-year prospective population-based study on pregnant women with uterine rupture in The Netherlands. J Matern Fetal Neonatal Med 2024; 37:2311083. [PMID: 38350236 DOI: 10.1080/14767058.2024.2311083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To estimate the incidence of uterine rupture in the Netherlands and evaluate risk indicators prelabour and during labor of women with adverse maternal and/or perinatal outcome. METHODS This is a population-based nationwide study using the Netherlands Obstetrics Surveillance System (NethOSS). We performed a two-year registration of pregnant women with uterine rupture. The first year of registration included both women with complete uterine rupture and women with incomplete (peritoneum intact) uterine rupture. The second year of registration included women with uterine rupture with adverse maternal and/or perinatal outcome. We collected maternal and obstetric characteristics, clinical signs, and symptoms during labor and CTG abnormalities. The main outcome measures were incidence of complete uterine rupture and uterine rupture with adverse outcome and adverse outcome defined as major obstetric hemorrhage, hysterectomy, embolization, perinatal asphyxia and/or (neonatal) intensive care unit admission. RESULTS We registered 41 women with a complete uterine rupture (incidence: 2.5 per 10,000 births) and 35 women with uterine rupture with adverse outcome (incidence: 0.9 per 10,000 births). No adverse outcomes were found among women with incomplete uterine rupture. Risk indicators for adverse outcome included previous cesarean section, higher maternal age, gestational age <37 weeks, augmentation of labor, migration background from Sub-Saharan Africa or Asia. Compared to women with uterine rupture without adverse outcomes, women with adverse outcome more often expressed warning symptoms during labor such as abdominal pain (OR 3.34, 95%CI 1.26-8.90) and CTG abnormalities (OR 9.94, 95%CI 2.17-45.65). These symptoms were present most often 20 to 60 min prior to birth. CONCLUSION Uterine rupture is a rare condition for which several risk indicators were identified. Maternal symptoms and CTG abnormalities are associated with adverse outcomes and time dependent. Further analysis could provide guidance to expedite delivery.
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Affiliation(s)
- E M Overtoom
- Department of Obstetrics, Birth Centre Wilhelmina Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, The Netherlands
| | - T N Huynh
- Department of Obstetrics, Birth Centre Wilhelmina Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - J J Zwart
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, The Netherlands
| | - T P Schaap
- Department of Obstetrics, Birth Centre Wilhelmina Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - T E Vogelvang
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, The Netherlands
| | - T van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics, Birth Centre Wilhelmina Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
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Amikam U, Hochberg A, Abramov S, Lavie A, Yogev Y, Hiersch L. Risk factors for maternal complications following uterine rupture: a 12-year single-center experience. Arch Gynecol Obstet 2024; 309:1863-1871. [PMID: 37149828 DOI: 10.1007/s00404-023-07061-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/25/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To determine maternal outcomes and risk factors for composite maternal morbidity following uterine rupture during pregnancy. METHODS A retrospective cohort study including all women diagnosed with uterine rupture during pregnancy, between 2011 and 2023, at a single-center. Patients with partial uterine rupture or dehiscence were excluded. We compared women who had composite maternal morbidity following uterine rupture to those without. Composite maternal morbidity was defined as any of the following: maternal death; hysterectomy; severe postpartum hemorrhage; disseminated intravascular coagulation; injury to adjacent organs; admission to the intensive care unit; or the need for relaparotomy. The primary outcome was risk factors associated with composite maternal morbidity following uterine rupture. The secondary outcome was the incidence of maternal and neonatal complications following uterine rupture. RESULTS During the study period, 147,037 women delivered. Of them, 120 were diagnosed with uterine rupture. Among these, 44 (36.7%) had composite maternal morbidity. There were no cases of maternal death and two cases of neonatal death (1.7%); packed cell transfusion was the major contributor to maternal morbidity [occurring in 36 patients (30%)]. Patients with composite maternal morbidity, compared to those without, were characterized by: increased maternal age (34.7 vs. 32.8 years, p = 0.03); lower gestational age at delivery (35 + 5 vs. 38 + 1 weeks, p = 0.01); a higher rate of unscarred uteri (22.7% vs. 2.6%, p < 0.01); and rupture occurring outside the lower uterine segment (52.3% vs. 10.5%, p < 0.01). CONCLUSION Uterine rupture entails increased risk for several adverse maternal outcomes, though possibly more favorable than previously described. Numerous risk factors for composite maternal morbidity following rupture exist and should be carefully assessed in these patients.
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Affiliation(s)
- Uri Amikam
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Alyssa Hochberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tiqva, Israel
| | - Shani Abramov
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Lavie
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Hiersch
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Xie J, Lu X, Liu M. Clinical analysis of complete uterine rupture during pregnancy. BMC Pregnancy Childbirth 2024; 24:255. [PMID: 38589817 PMCID: PMC11000347 DOI: 10.1186/s12884-024-06394-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 03/05/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Uterine rupture in pregnant women can lead to serious adverse outcomes. This study aimed to explore the clinical characteristics, treatment, and prognosis of patients with complete uterine rupture. METHODS Data from 33 cases of surgically confirmed complete uterine rupture at Chenzhou No.1 People's Hospital between January 2015 and December 2022 were analyzed retrospectively. RESULTS In total, 31,555 pregnant women delivered in our hospital during the study period. Of these, approximately 1‰ (n = 33) had complete uterine rupture. The average gestational age at complete uterine rupture was 31+4 weeks (13+1-40+3 weeks), and the average bleeding volume was 1896.97 ml (200-6000 ml). Twenty-six patients (78.79%) had undergone more than two deliveries. Twenty-five women (75.76%) experienced uterine rupture after a cesarean section, two (6.06%) after fallopian tube surgery, one (3.03%) after laparoscopic cervical cerclage, and one (3.03%) after wedge resection of the uterine horn, and Fifteen women (45.45%) presented with uterine rupture at the original cesarean section incision scar. Thirteen patients (39.39%) were transferred to our hospital after their initial diagnosis. Seven patients (21.21%) had no obvious symptoms, and only four patients (12.12%) had typical persistent lower abdominal pain. There were 13 cases (39.39%, including eight cases ≥ 28 weeks old) of fetal death in utero and two cases (6.06%, both full term) of severe neonatal asphyxia. The rates of postpartum hemorrhage, blood transfusion, hysterectomy were 66.67%, 63.64%, and 21.21%. Maternal death occurred in one case (3.03%). CONCLUSIONS The site of the uterine rupture was random, and was often located at the weakest point of the uterus. There is no effective means for detecting or predicting the weakest point of the uterus. Rapid recognition is key to the treatment of uterine rupture.
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Affiliation(s)
- Jing Xie
- The Chenzhou No.1 People's Hospital, Chenzhou, 423000, China
- The First Affiliated Hospital of Xiangnan University, Chenzhou, 423000, China
| | - Xuefang Lu
- Department of Radiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, China.
| | - Miao Liu
- The Chenzhou No.1 People's Hospital, Chenzhou, 423000, China
- The First Affiliated Hospital of Xiangnan University, Chenzhou, 423000, China
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Caning MM, Rasmussen SC, Krebs L. Maternal outcomes of planned mode of delivery for term breech in nulliparous women. PLoS One 2024; 19:e0297971. [PMID: 38568924 PMCID: PMC10990212 DOI: 10.1371/journal.pone.0297971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/15/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To estimate short- and long-term maternal complications in relation to planned mode of term breech delivery in first pregnancy. DESIGN Register-based cohort study. SETTING Denmark. POPULATION Nulliparous women with singleton breech delivery at term between 1991 and 2018 (n = 30,778). METHODS We used data from the Danish national health registries to identify nulliparous women with singleton breech presentation at term and their subsequent pregnancies. We performed logistic regression to compare the risks of maternal complications by planned mode of delivery. All data were proceeded and statistical analyses were performed in SAS 9.4 (SAS Institute Inc. Cary, NC, USA). MAIN OUTCOME MEASURES Postpartum hemorrhage, operative complications, puerperal infections in first pregnancy and uterine rupture, placenta previa, post-partum hemorrhage, hysterectomy and stillbirth in the subsequent two pregnancies. RESULTS We identified 19,187 with planned cesarean and 9,681 with planned vaginal breech delivery of which 2,970 (30.7%) delivered vaginally. Planned cesarean significantly reduced the risk of postoperative infections (2.4% vs 3.9% adjusted odds ratio (aOR): 0.54 95% confidence interval (CI) 0.44-0.66) and surgical organ lesions (0.06% vs 0.1%; (aOR): 0.29 95% CI 0.11-0.76) compared to planned vaginal breech delivery. Planned cesarean delivery in the first pregnancy was associated with a significantly higher risk of uterine rupture in the subsequent pregnancies but not with risk of postpartum hemorrhage, placenta previa, hysterectomy, or stillbirth. CONCLUSION Compared to planned vaginal breech delivery at term, nulliparous women with planned cesarean breech delivery have a significantly reduced risk of postoperative complications but a higher risk of uterine rupture in their subsequent pregnancies.
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Affiliation(s)
- Malene Mie Caning
- Department of Gynecology and Obstetrics, University of Copenhagen, Holbaek Hospital, Holbaek, Denmark
- Department of Gynecology and Obstetrics, Herlev Hospital, Herlev, Denmark
| | - Steen Christian Rasmussen
- Department of Gynecology and Obstetrics, University of Copenhagen, Amager Hvidovre Hospital, Hvidovre, Denmark
| | - Lone Krebs
- Department of Gynecology and Obstetrics, University of Copenhagen, Amager Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
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Levy R, Sela HY, Weiss A, Rotem R, Grisaru-Granovsky S, Rottenstreich M. Impact of prior use of topical hemostatic agents on trial of labor after cesarean: Insights from a multicenter cohort study. Int J Gynaecol Obstet 2024; 165:203-210. [PMID: 37675895 DOI: 10.1002/ijgo.15089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To evaluate the association between a topical hemostatic agent used at the time of cesarean delivery and uterine scar disruption (rupture or dehiscence) at the subsequent trial of labor after cesarean (TOLAC). METHODS A multicenter retrospective cohort study was conducted (2005-2021). Parturients with a singleton pregnancy in whom a topical hemostatic agent was placed during the primary cesarean delivery were compared with patients in whom no such agent was placed. We assessed the uterine scar disruption rate after the subsequent TOLAC and the rate of adverse maternal outcomes. Univariate analyses were followed by multivariate analysis (adjusted odds ratio [aOR]; 95% confidence interval [CI]). RESULTS During the study period, 7199 women underwent a trial of labor and were eligible for the study; 430 (6.0%) had prior use of a hemostatic agent, 6769 (94.0%) did not. In univariate analysis, a history of topical hemostatic agent use was not found to be significantly associated with uterine scar rupture, dehiscence, or failed trial of labor. This was also confirmed on multivariate analysis for uterine rupture (aOR 1.91, 95% CI 0.66-5.54; P = 0.23), dehiscence of uterine scar (aOR 1.62, 95% CI 0.56-4.68; P = 0.37), and TOLAC failure (aOR 1.08, 95% CI 0.79-1.48; P = 0.61). CONCLUSION A history of hemostatic agent use is not associated with an increased risk for uterine scar disruption after subsequent TOLAC. Further prospective studies in other settings are needed to strengthen these findings.
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Affiliation(s)
- Romi Levy
- Department of Military Medicine and "Tzameret," Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Medical Corps, Israel Defense Forces, Israel
| | - Hen Y Sela
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Ari Weiss
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
- Department of Obstetrics and Gynecology, McMaster University Medical Center, McMaster University, Hamilton, Ontario, Canada
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
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Habek D, Orešković N. Silent fundal pre-labor term scar uterine rupture after corporeal cesarean section. Arch Gynecol Obstet 2024; 309:1669-1670. [PMID: 37840049 DOI: 10.1007/s00404-023-07255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Dubravko Habek
- Department of Gynecology and Obstetrics Clinical Hospital Merkur Zagreb, School of Medicine, Catholic University of Croatia Zagreb, Croatian Academy of Medical Sciences Zagreb, Ilica 242, 10 000, Zagreb, Croatia.
| | - Nika Orešković
- Clinical Hospital Clinical Hospital Centre "Sister of Mercy", Zagreb, Croatia
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Ryberg J, Carlsson Y, Svensson M, Thunström E, Svanvik T. Risk of uterine rupture in multiparous women after induction of labor with prostaglandin: A national population-based cohort study. Int J Gynaecol Obstet 2024; 165:328-334. [PMID: 37925605 DOI: 10.1002/ijgo.15208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/22/2023] [Accepted: 10/08/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE To assess whether, after induction of labor with prostaglandin, multiparous (≥2 para) women have an increased risk of uterine rupture compared with nulliparous or uniparous women. METHODS This was a retrospective population-based cohort study including women who underwent induction with prostaglandin in all maternity wards in Sweden between May 1996 and December 2019 (n = 56 784). The study cohort was obtained by using data from the Swedish Medical Birth Register, which contains information from maternity and delivery records. The main outcome measure was uterine rupture. RESULTS Overall, multiparous women induced with prostaglandin had an increased risk of uterine rupture compared with nulliparous women (adjusted odds ratio [OR], 3.33 [95% confidence interval (CI), 1.38-8.04]; P < 0.007). Multiparous women with no previous cesarean section (CS) induced with prostaglandin had more than three times higher risk of uterine rupture (crude OR, 3.55 [95% Cl, 1.48-8.53]; P = 0.005) compared with nulliparous women and four times higher risk compared with uniparous women (OR, 4.10 [95% CI, 1.12-15.00]; P < 0.033). Multiparous women with previous CS had a decreased risk of uterine rupture compared with uniparous women with one previous CS (crude OR, 0.41 [95% Cl, 0.21-0.78]; P = 0.007). CONCLUSION Our study implies that multiparity in women with no previous CS is a risk factor for uterine rupture when induced with prostaglandin. This should be taken into consideration when deciding on the appropriate method of induction.
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Affiliation(s)
- Johanna Ryberg
- Department of Obstetrics and Gynecology, Hallands Sjukhus Halmstad, Halmstad, Sweden
| | - Ylva Carlsson
- Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Svensson
- Department of Mathematics and Computer Science, Faculty of Science, University of Southern Denmark, Odense, Denmark
| | - Erik Thunström
- Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Teresia Svanvik
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Amikam U, Hochberg A, Segal R, Abramov S, Lavie A, Yogev Y, Hiersch L. Perinatal outcomes following uterine rupture during a trial of labor after cesarean: A 12-year single-center experience. Int J Gynaecol Obstet 2024; 165:237-243. [PMID: 37818982 DOI: 10.1002/ijgo.15178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 07/24/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To determine perinatal outcomes following uterine rupture during a trial of labor after one previous cesarean delivery (CD) at term. METHODS A retrospective single-center study examining perinatal outcomes in women with term singleton pregnancies with one prior CD, who underwent a trial of labor after cesarean (TOLAC) and were diagnosed with uterine rupture, between 2011 and 2022. The primary outcome was a composite maternal outcome, and the secondary outcome was a composite neonatal outcome. Additionally, we compared perinatal outcomes between patients receiving oxytocin during labor with those who did not. RESULTS Overall, 6873 women attempted a TOLAC, and 116 were diagnosed with uterine rupture. Among them, 63 (54.3%) met the inclusion criteria, and 18 (28%) had the maternal composite outcome, with no cases of maternal death. Sixteen cases (25.4%) had the composite neonatal outcome, with one case (1.6%) of perinatal death. No differences were noted between women receiving oxytocin and those not receiving oxytocin in the rates of maternal composite (35.7% vs 26.5%, P = 0.502, respectively) or neonatal composite outcomes (21.4% vs 26.5%, P = 0.699). CONCLUSION Uterine rupture during a TOLAC entails increased risk for myriad adverse outcomes for the mother and neonate, though possibly more favorable than previously described. Oxytocin use does not affect these risks.
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Affiliation(s)
- Uri Amikam
- Lis Hospital for Women, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alyssa Hochberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
| | - Roy Segal
- Lis Hospital for Women, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shani Abramov
- Lis Hospital for Women, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Lavie
- Lis Hospital for Women, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Lis Hospital for Women, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Hiersch
- Lis Hospital for Women, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Yin Y, Wang L, Shi Z, Ma Y, Yina J. Spontaneous uterine rupture with amniotic sac protrusion during the third trimester of a unicornuate uterus pregnancy: A rate case report. Medicine (Baltimore) 2024; 103:e37445. [PMID: 38489687 PMCID: PMC10939673 DOI: 10.1097/md.0000000000037445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/09/2024] [Indexed: 03/17/2024] Open
Abstract
RATIONALE Uterine rupture is an obstetrical emergency associated with severe maternal and fetal mortality. It is rare in the unscarred uterus of a primipara. PATIENT CONCERNS A 25-year-old woman in her 38th week of gestation presented with slight abdominal pain of sudden onset 10 hours before. An emergency cesarean section was done. After surgery, the patient and the infant survived. DIAGNOSES With slight abdominal pain of clinical signs, ultrasound examination showed that the amniotic sac was found in the peritoneal cavity with a rupture of the uterine fundus. INTERVENTIONS Uterine repair and right salpingectomy. OUTCOMES After surgery, the patient and the infant survived. The newborn weighed 2600 g and had an Apgar score of 10 points per minute. Forty-two days after delivery, the uterus recovered well. LESSONS Spontaneous uterine rupture should be considered in patients even without acute pain, regardless of gestational age, and pregnancy with abdominal cystic mass should consider the possibility of uterine rupture.
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Affiliation(s)
- Yin Yin
- Department of Ultrasound, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Linlin Wang
- Medical Imaging Department, Central Laboratory, Jinan Key Laboratory of Oral Tissue Regeneration, Jinan Stomatological Hospital, Jinan, China
| | - Zhihong Shi
- Department of Ultrasound, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yuxin Ma
- Medical Imaging Department, Central Laboratory, Jinan Key Laboratory of Oral Tissue Regeneration, Jinan Stomatological Hospital, Jinan, China
| | - Juan Yina
- Department of Ultrasound, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
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11
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Shao L, Yang Z, Yan H, Xu R. Uterine rupture in patients with a history of hysteroscopy procedures: Case series and review of literature. Medicine (Baltimore) 2024; 103:e37428. [PMID: 38457539 PMCID: PMC10919467 DOI: 10.1097/md.0000000000037428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 03/10/2024] Open
Abstract
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.
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Affiliation(s)
- Liping Shao
- Department of Obstetrics and Gynecology, Changzhou Cancer Hospital Changzhou Fourth People’s Hospital, Changzhou, Jiangsu, China
| | - Zhilong Yang
- Department of General Surgery, Nanjing Lishui People’s Hospital, Nanjing, Jiangsu, China
| | - Huifang Yan
- Department of Obstetrics and Gynecology, Nanjing Lishui People’s Hospital, Nanjing, Jiangsu, China
| | - Rong Xu
- Department of Obstetrics and Gynecology, Nanjing Lishui People’s Hospital, Nanjing, Jiangsu, China
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12
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Chen L, Li H, Peng J, Li M, Wang Y, Zhao K, Yang L, Zhao Y. Silent uterine rupture in the term pregnancy: Three case reports. Medicine (Baltimore) 2024; 103:e37071. [PMID: 38457586 PMCID: PMC10919461 DOI: 10.1097/md.0000000000037071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/10/2023] [Accepted: 11/20/2023] [Indexed: 03/10/2024] Open
Abstract
RATIONALE Uterine rupture is extremely hazardous to both mothers and infants. Diagnosing silent uterine rupture in pregnant women without uterine contractions is challenging due to the presence of nonspecific symptoms, signs, and laboratory indicators. Therefore, it is crucial to identify the elevated risks associated with silent uterine rupture. PATIENT CONCERNS on admission, case 1 was at 37 gestational weeks, having undergo laparoscopic transabdominal cerclage 8 months prior to the in vitro fertilization embryo transfer procedure, case 2 was at 38 4/7 gestational weeks with a history of 5 previous artificial abortion and 2 previous vaginal deliveries, case 3 was at 37 6/7 gestational weeks with a history of laparoscopic myomectomy. DIAGNOSES The diagnosis of silent uterine rupture was based on clinical findings from cesarean delivery or laparoscopic exploration. INTERVENTIONS Case 1 underwent emergent cesarean delivery, revealing a 0.25 cm × 0.25 cm narrow concave area above the Ring Ties with active and bright amniotic fluid flowing from the tear. Case 2 underwent vaginal delivery, and on the 12th postpartum day, ultrasound imaging and magnetic resonance imaging revealed a 5.8 cm × 3.3 cm × 2.3 cm lesion on the lower left posterior wall of the uterus, and 15th postpartum day, laparoscopic exploration confirmed the presence of an old rupture of uterus. Case 3 underwent elective cesarean delivery, revealing a 3.0 cm × 2.0 cm uterine rupture without active bleeding at the bottom of the uterus. OUTCOMES The volumes of antenatal bleeding for the 3 patients were approximately 500 mL, 320 mL, and 400 mL, respectively. After silent uterine ruptures were detected, the uterine tear was routinely repaired. No maternal or neonatal complications were reported. LESSONS Obstetricians should give particular consideration to the risk factors for silent uterine rupture, including a history of uterine surgery, such as laparoscopic transabdominal cerclage, laparoscopic myomectomy, and induced abortion.
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Affiliation(s)
- Lei Chen
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Hongshan District, Wuhan, China
| | - Hao Li
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Hongshan District, Wuhan, China
| | - Jing Peng
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Hongshan District, Wuhan, China
| | - Min Li
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Hongshan District, Wuhan, China
| | - Ying Wang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Hongshan District, Wuhan, China
| | - Kai Zhao
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Qiaokou District, Wuhan, China
| | - Lijun Yang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Hongshan District, Wuhan, China
| | - Yun Zhao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Hongshan District, Wuhan, China
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13
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Deshmukh U, Denoble AE, Son M. Trial of labor after cesarean, vaginal birth after cesarean, and the risk of uterine rupture: an expert review. Am J Obstet Gynecol 2024; 230:S783-S803. [PMID: 38462257 DOI: 10.1016/j.ajog.2022.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 03/12/2024]
Abstract
The decision to pursue a trial of labor after cesarean delivery is complex and depends on patient preference, the likelihood of successful vaginal birth after cesarean delivery, assessment of the risks vs benefits of trial of labor after cesarean delivery, and available resources to support safe trial of labor after cesarean delivery at the planned birthing center. The most feared complication of trial of labor after cesarean delivery is uterine rupture, which can have catastrophic consequences, including substantial maternal and perinatal morbidity and mortality. Although the absolute risk of uterine rupture is low, several clinical, historical, obstetrical, and intrapartum factors have been associated with increased risk. It is therefore critical for clinicians managing patients during trial of labor after cesarean delivery to be aware of these risk factors to appropriately select candidates for trial of labor after cesarean delivery and maximize the safety and benefits while minimizing the risks. Caution is advised when considering labor augmentation and induction in patients with a previous cesarean delivery. With established hospital safety protocols that dictate close maternal and fetal monitoring, avoidance of prostaglandins, and careful titration of oxytocin infusion when induction agents are needed, spontaneous and induced trial of labor after cesarean delivery are safe and should be offered to most patients with 1 previous low transverse, low vertical, or unknown uterine incision after appropriate evaluation, counseling, planning, and shared decision-making. Future research should focus on clarifying true risk factors and identifying the optimal approach to intrapartum and induction management, tools for antenatal prediction, and strategies for prevention of uterine rupture during trial of labor after cesarean delivery. A better understanding will facilitate patient counseling, support efforts to improve trial of labor after cesarean delivery and vaginal birth after cesarean delivery rates, and reduce the morbidity and mortality associated with uterine rupture during trial of labor after cesarean delivery.
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Affiliation(s)
- Uma Deshmukh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA
| | - Annalies E Denoble
- Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT
| | - Moeun Son
- Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT.
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14
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Romero R, Sabo Romero V, Kalache KD, Stone J. Parturition at term: induction, second and third stages of labor, and optimal management of life-threatening complications-hemorrhage, infection, and uterine rupture. Am J Obstet Gynecol 2024; 230:S653-S661. [PMID: 38462251 DOI: 10.1016/j.ajog.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Childbirth is a defining moment in anyone's life, and it occurs 140 million times per year. Largely a physiologic process, parturition does come with risks; one mother dies every two minutes. These deaths occur mostly among healthy women, and many are considered preventable. For each death, 20 to 30 mothers experience complications that compromise their short- and long-term health. The risk of birth extends to the newborn, and, in 2020, 2.4 million neonates died, 25% in the first day of life. Hence, intrapartum care is an important priority for society. The American Journal of Obstetrics & Gynecology has devoted two special Supplements in 2023 and 2024 to the clinical aspects of labor at term. This article describes the content of the Supplements and highlights new developments in the induction of labor (a comparison of methods, definition of failed induction, new pharmacologic agents), management of the second stage, the value of intrapartum sonography, new concepts on soft tissue dystocia, optimal care during the third stage, and common complications that account for maternal death, such as infection, hemorrhage, and uterine rupture. All articles are available to subscribers and non-subscribers and have supporting video content to enhance dissemination and improve intrapartum care. Our hope is that no mother suffers because of lack of information.
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Affiliation(s)
- Roberto Romero
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI.
| | | | - Karim D Kalache
- Department of Clinical Obstetrics and Gynecology, Weill Cornell Medical College-Qatar Division, Doha, Qatar; Division of Maternal-Fetal Medicine, Women's Services, Sidra Medicine, Doha, Qatar
| | - Joanne Stone
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY
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15
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Komatsu EJ, Matsuzaki S, Mazza GR, Brueggmann D, Mandelbaum RS, Ouzounian JG, Matsuo K. Assessment of uterine rupture in placenta accreta spectrum: pre-labor vs in-labor. Am J Obstet Gynecol 2024; 230:e14-e16. [PMID: 38453289 DOI: 10.1016/j.ajog.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/19/2023] [Accepted: 11/03/2023] [Indexed: 03/09/2024]
Affiliation(s)
- Emi J Komatsu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Shinya Matsuzaki
- Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan
| | - Genevieve R Mazza
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Doerthe Brueggmann
- Department of Obstetrics and Gynecology, University of Frankfurt Faculty of Medicine, Frankfurt, Germany
| | - Rachel S Mandelbaum
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Joseph G Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue IRD 520, Los Angeles, CA 90033; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
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16
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Isikhuemen ME, Imarengiaye CA, Oyelade TA, Okonofua FE. Spontaneous second trimester rupture of a previous caesarean section scar: A case report. Afr J Reprod Health 2024; 28:125-128. [PMID: 38426295 DOI: 10.29063/ajrh2024/v28i2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Spontaneous uterine rupture before the onset of labour is rare in pregnancy especially before the third trimester. It is life threatening with devastating consequences to the mother and fetus. We report a case of spontaneous second trimester uterine rupture in a multipara with a previous uterine scar with the aim of creating awareness and sharing the challenges in diagnosis and management of this unusual complication of pregnancy. A 34-year-old woman with two previous deliveries presented at 16 weeks gestation with abdominal pain and vaginal bleeding of one day duration. At presentation, she was pale and in shock. There was generalized abdominal tenderness with guarding and rebound tenderness. At laparotomy, there was uterine rupture involving the lower segment with right lateral upward extension which was repaired. She remained stable at the follow up visit. In conclusion, Spontaneous uterine rupture of a previous caesarean section scar in the second trimester is rare. The diagnosis should be considered in a woman with previous caesarean section who experience an acute abdomen in the second trimester of pregnancy.
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Affiliation(s)
- Maradona E Isikhuemen
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Edo State, Nigeria
| | | | | | - Friday E Okonofua
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Edo State, Nigeria
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17
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Chen X, Mi MY. The impact of a trial of labor after cesarean versus elective repeat cesarean delivery: A meta-analysis. Medicine (Baltimore) 2024; 103:e37156. [PMID: 38363952 PMCID: PMC10869045 DOI: 10.1097/md.0000000000037156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/11/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The increasing global incidence of cesarean section has prompted efforts to reduce cesarean delivery rates. A trial of labor after cesarean (TOLAC) has emerged as an alternative to elective repeat cesarean delivery (ERCD) for women with a prior cesarean delivery. However, the available evidence on the comparative outcomes of these 2 options remains inconsistent, primarily due to varying advantages and risks associated with each. Our meta-analysis aims to compare the maternal-neonatal results in TOLAC and ERCD in women with prior cesarean deliveries. METHODS A comprehensive search was performed in PubMed, Embase, Cochrane library databases up to September,2022 to identity studies evaluating perinatal outcomes in women who underwent TOLAC compared to ERCD following a previous cesarean delivery. The included studies were subjected to meta-analysis using RevMan 5.3 software to assess the overall findings. RESULTS A total of 13 articles were included in this meta-analysis. Statistically significant differences were identified in the rate of uterine rupture (OR = 2.01,95%CI = 1.48-2.74, P < .00001) and APGAR score < 7 at 5 minutes (OR = 2.17,95%CI = 1.69-2.77, P < .00001) between the TOLAC and ERCD groups. However, no significant differences were observed in the rates of hysterectomy, maternal blood transfusion, postpartum infection, postpartum hemorrhage and neonatal intensive care unit (P ≥ .05) admission between the 2 groups. CONCLUSIONS Our analysis revealed that TOLAC is associated with a higher risk of uterine rupture and lower incidence APGAR score < 7 at 5 minutes compared to ERCD. It is vital to consider predictive factors when determining the appropriate mode of delivery in order to ensure optimal pregnancy outcomes. Efforts should be made to identify the underlying causes of adverse outcomes and implement safety precautions to select suitable participants and create safe environments for TOLAC.
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Affiliation(s)
- Xiao Chen
- Department of Gynecology and Obstetrics, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
| | - Mei-yan Mi
- Department of Gynecology and Obstetrics, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
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18
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Asghar AK, Naidoo E. Context-sensitive holistic care of women with one previous Caesarean section. S Afr Fam Pract (2004) 2024; 66:e1-e4. [PMID: 38299517 PMCID: PMC10839215 DOI: 10.4102/safp.v66i1.5879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/17/2023] [Indexed: 02/02/2024] Open
Abstract
This article's emphasis is on the holistic care of women who are assessed as suitable for and amenable to vaginal birth after Caesarean section (VBAC) in the South African state health sector context. It is beyond its scope to deal with the minutiae of VBAC conduct, operative conduct of repeat Caesarean section (CS), or management of uterine rupture. It is also beyond the scope of the article to reflect on practices, which are accepted in other healthcare contexts. The intention is not to promote VBAC over elective repeat CS, but rather to assist healthcare workers with providing high-quality holistic care. The goal is that women with previous CS are given access to the mode of delivery, which is safest for them and their fetus, while minimising adverse psychological effects of previous and future negative birth experiences.
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Affiliation(s)
- Adam K Asghar
- Department of Family Medicine, KwaZulu-Natal Department of Health, Durban.
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19
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Lin MM, Ge YM, Yang S, Yang R, Li R. [Rudimentary horn pregnancy: clinical analysis of 12 cases and literature review]. Zhonghua Fu Chan Ke Za Zhi 2024; 59:49-55. [PMID: 38228515 DOI: 10.3760/cma.j.cn112141-20231112-00184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Objective: To investigate the clinical characteristics, treatments and fertility recovery of rudimentary horn pregnancy (RHP). Methods: The clinical data of 12 cases with RHP diagnosed and treated in Peking University Third Hospital from January 1, 2010 to December 31, 2022 were retrospectively analyzed. Clinical informations, diagnosis and treatments of RHP and the pregnancy status after surgery were analyzed. Results: The median age of 12 RHP patients was 29 years (range: 24-37 years). Eight cases of pregnancy in residual horn of uterus occurred in type Ⅰ residual horn of uterus, 4 cases occurred in type Ⅱ residual horn of uterus; among which 5 cases were misdiagnosed by ultrasound before surgery. All patients underwent excision of residual horn of uterus and affected salpingectomy. After surgery, 9 patients expected future pregnancy, and 3 cases of natural pregnancy, 2 cases of successful pregnancy through assisted reproductive technology. Four pregnancies resulted in live birth with cesarean section, and 1 case resulted in spontaneous abortion during the first trimester of pregnancy. No uterine rupture or ectopic pregnancy occurred in subsequent pregnancies. Conclusions: Ultrasonography could aid early diagnosis of RHP while misdiagnosis occurred in certain cases. Thus, a comprehensive judgment and decision ought to be made based on medical history, physical examination and assisted examination. Surgical exploration is necessary for diagnosis and treatment of RHP. For infertile patients, assisted reproductive technology should be applied when necessary. Caution to prevent the occurrence of pregnancy complications such as uterine rupture, and application of cesarean section to terminate pregnancy are recommended.
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Affiliation(s)
- M M Lin
- Department of Obstetrics and Gynecology, Peking University Third Hospital, National Clinical Research Center for Obstetric and Gynecologic Diseases, Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Y M Ge
- Department of Obstetrics and Gynecology, Peking University Third Hospital, National Clinical Research Center for Obstetric and Gynecologic Diseases, Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - S Yang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, National Clinical Research Center for Obstetric and Gynecologic Diseases, Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - R Yang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, National Clinical Research Center for Obstetric and Gynecologic Diseases, Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - R Li
- Department of Obstetrics and Gynecology, Peking University Third Hospital, National Clinical Research Center for Obstetric and Gynecologic Diseases, Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
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20
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Mutiso SK, Oindi FM, Mundia DM. Uterine rupture in the first trimester: a case report and review of the literature. J Med Case Rep 2024; 18:5. [PMID: 38183151 PMCID: PMC10771000 DOI: 10.1186/s13256-023-04318-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/12/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Uterine rupture is a rare complication that can occur in the first trimester of pregnancy. It can lead to serious maternal morbidity or mortality, which is mostly due to catastrophic bleeding. First trimester uterine rupture is rare; hence, diagnosis can be challenging as it may be confused with other causes of early pregnancy bleeding such as an ectopic pregnancy. We present a case of first trimester scar dehiscence and conduct a literature review of this rare condition. CASE PRESENTATION A 39-year-old African patient with four previous hysterotomy scars presented with severe lower abdominal pain at 11 weeks of gestation. She had two previous histories of third trimester uterine rupture in previous pregnancies with subsequent hysterotomies and repair. She underwent a diagnostic laparoscopy that confirmed the diagnosis of a 10 cm anterior wall uterine rupture. A laparotomy and repair of the rupture was subsequently done. CONCLUSION In conclusion, the case presented adds to the body of evidence of uterine scar dehiscence in the first trimester. The risk factors, clinical presentation, diagnostic imaging, and management outlined may help in early identification and management of this rare but life threatening condition.
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Affiliation(s)
- Steve Kyende Mutiso
- Department of Obstetrics and Gynaecology, Aga-Khan University, P.O. Box 30270-00100, Nairobi, Kenya.
| | - Felix Mwembi Oindi
- Department of Obstetrics and Gynaecology, Aga-Khan University, P.O. Box 30270-00100, Nairobi, Kenya
| | - Debbie Muthoni Mundia
- Department of Obstetrics and Gynaecology, Aga-Khan University, P.O. Box 30270-00100, Nairobi, Kenya
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21
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Chaillet N, Mâsse B, Grobman WA, Shorten A, Gauthier R, Rozenberg P, Dugas M, Pasquier JC, Audibert F, Abenhaim HA, Demers S, Piedboeuf B, Fraser WD, Gagnon R, Gagné GP, Francoeur D, Girard I, Duperron L, Bédard MJ, Johri M, Dubé E, Blouin S, Ducruet T, Girard M, Bujold E. Perinatal morbidity among women with a previous caesarean delivery (PRISMA trial): a cluster-randomised trial. Lancet 2024; 403:44-54. [PMID: 38096892 DOI: 10.1016/s0140-6736(23)01855-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/20/2023] [Accepted: 08/31/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Women with a previous caesarean delivery face a difficult choice in their next pregnancy: planning another caesarean or attempting vaginal delivery, both of which are associated with potential maternal and perinatal complications. This trial aimed to assess whether a multifaceted intervention, which promoted person-centred decision making and best practices, would reduce the risk of major perinatal morbidity among women with one previous caesarean delivery. METHODS We conducted an open, multicentre, cluster-randomised, controlled trial of a multifaceted 2-year intervention in 40 hospitals in Quebec among women with one previous caesarean delivery, in which hospitals were the units of randomisation and women the units of analysis. Randomisation was stratified according to level of care, using blocked randomisation. Hospitals were randomly assigned (1:1) to the intervention group (implementation of best practices and provision of tools that aimed to support decision making about mode of delivery, including an estimation of the probability of vaginal delivery and an ultrasound estimation of the risk of uterine rupture), or the control group (no intervention). The primary outcome was a composite risk of major perinatal morbidity. This trial was registered with ISRCTN, ISRCTN15346559. FINDINGS 21 281 eligible women delivered during the study period, from April 1, 2016 to Dec 13, 2019 (10 514 in the intervention group and 10 767 in the control group). None were lost to follow-up. There was a significant reduction in the rate of major perinatal morbidity from the baseline period to the intervention period in the intervention group as compared with the control group (adjusted odds ratio [OR] for incremental change over time, 0·72 [95% CI 0·52-0·99]; p=0·042; adjusted risk difference -1·2% [95% CI -2·0 to -0·1]). Major maternal morbidity was significantly reduced in the intervention group as compared with the control group (adjusted OR 0·54 [95% CI 0·33-0·89]; p=0·016). Minor perinatal and maternal morbidity, caesarean delivery, and uterine rupture rates did not differ significantly between groups. INTERPRETATION A multifaceted intervention supporting women in their choice of mode of delivery and promoting best practices resulted in a significant reduction in rates of major perinatal and maternal morbidity, without an increase in the rate of caesarean or uterine rupture. FUNDING Canadian Institutes of Health Research (CIHR, MOP-142448).
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Affiliation(s)
- Nils Chaillet
- CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada.
| | - Benoît Mâsse
- School of Public Health, University of Montreal, Montreal, QC, Canada; CHU Ste-Justine Research Center, Montreal, QC, Canada
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - Allison Shorten
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Gauthier
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Patrick Rozenberg
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, Poissy, France
| | - Marylène Dugas
- Department of Health Sciences, Interdisciplinary Research Chair in Rural Health and Social Services, University of Quebec at Rimouski, Rimouski, QC, Canada
| | - Jean-Charles Pasquier
- Department of Obstetrics and Gynecology, Sherbrooke University, Sherbrooke, QC, Canada
| | - François Audibert
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada; CHU Ste-Justine Research Center, Montreal, QC, Canada
| | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Suzanne Demers
- CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Laval University, Quebec, QC, Canada
| | - William D Fraser
- Department of Obstetrics and Gynecology, Sherbrooke University, Sherbrooke, QC, Canada
| | - Robert Gagnon
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Guy-Paul Gagné
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Diane Francoeur
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Isabelle Girard
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Louise Duperron
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Marie-Josée Bédard
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Mira Johri
- School of Public Health, University of Montreal, Montreal, QC, Canada; University of Montreal Hospital Research Center, University of Montreal, QC, Canada
| | - Eric Dubé
- Research Center of the CHU de Québec-Université Laval, Laval University, Quebec, QC, Canada
| | - Simon Blouin
- Research Center of the CHU de Québec-Université Laval, Laval University, Quebec, QC, Canada
| | | | - Mario Girard
- Research Center of the CHU de Québec-Université Laval, Laval University, Quebec, QC, Canada
| | - Emmanuel Bujold
- CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada
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Houri O, Romano A, Geron Y, Zeevi G, Hadar E, Barbash-Hazan S, Danieli-Gruber S. Outcome of subsequent pregnancies in women with prior uterine rupture. Eur J Obstet Gynecol Reprod Biol 2024; 292:97-101. [PMID: 37992425 DOI: 10.1016/j.ejogrb.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/20/2023] [Accepted: 11/18/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To report maternal and neonatal outcomes of subsequent pregnancies in a series of women with a prior uterine rupture. METHODS The records of all 103,542 deliveries (22,286 by cesarean section) performed in a single tertiary medical center from 2009 to 2021 were reviewed. Women with a prior uterine rupture, defined as a separation of the entire thickness of the uterine wall, with extrusion of fetal parts and intra-amniotic contents into the peritoneal cavity documented in the operative report of the previous cesarean delivery or laparotomy, were identified for inclusion in the study. RESULTS The cohort included 38 women with 50 pregnancies (50 neonates). Women had been scheduled for elective cesarean delivery at early term. Mean gestational age at delivery was 36 + 4 weeks (±5 days). In 7 pregnancies (14 %), spontaneous labor occurred before the scheduled cesarean delivery (at 36 + 6, 35 + 4, 35 + 3, 34 + 6, 34 + 3, 32 + 6 and 31 + 0 gestational weeks). A recurrent uterine scar rupture was found in 4 pregnancies (8 %), and uterine scar dehiscence, in 2 pregnancies (4 %), all identified during elective repeat cesarean delivery. In none of these cases was there a clinical suspicion beforehand; all had good maternal and neonatal outcomes. One parturient with placenta previa-accreta had a planned cesarean hysterectomy. CONCLUSION Women with prior uterine rupture have good maternal and neonatal outcomes in subsequent pregnancies when managed at a tertiary medical center, with planned elective term cesarean delivery, or even earlier, at the onset of spontaneous preterm labor.
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Affiliation(s)
- Ohad Houri
- Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Asaf Romano
- Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Geron
- Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Zeevi
- Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shiri Barbash-Hazan
- Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Danieli-Gruber
- Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Phillips L, Brown H, Williams A. Uterine rupture of an unscarred gravid uterus at term attributed to adenomyosis. BMJ Case Rep 2023; 16:e257145. [PMID: 38086577 PMCID: PMC10728938 DOI: 10.1136/bcr-2023-257145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Uterine rupture is a rare obstetric emergency that is typically associated with the presence of scar tissue such as in the case of previous caesarean section. In this case report, a primigravid patient presented to the hospital in cardiac arrest with massive haemoperitoneum secondary to a posterior uterine rupture. The histological specimen was found to have diffuse adenomyosis at the site of rupture. On review of the literature, there is insufficient evidence to suggest we as clinicians should alter the antenatal care for patients with known adenomyosis; however, this case highlights how we should have a high index of suspicion for those presenting with signs and symptoms of uterine rupture with known adenomyosis in the absence of other risk factors.
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Affiliation(s)
- Lucy Phillips
- Obstetrics and Gynaecology, Royal Sussex County Hospital, Brighton, UK
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Zheng J, Zhou L, Hu J. Spontaneous unscarred uterine rupture at 13 weeks of gestation after in vitro fertilization-embryo transfer: A case report and literature review. Medicine (Baltimore) 2023; 102:e36254. [PMID: 38065862 PMCID: PMC10713178 DOI: 10.1097/md.0000000000036254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
RATIONALE Uterine rupture (UR) during pregnancy is a serious obstetric complication. Here we report a case of spontaneous rupture in an unscarred uterus at 13 weeks of gestation after in vitro fertilization embryo transfer, which is not common in past references. Our focus is to understand the relationship between systemic lupus erythematosus (SLE) and UR. PATIENT CONCERNS A 33-year-old infertile woman with a history of SLE became pregnant after in vitro fertilization embryo transfer. She presented with sudden mental fatigue and dyspnea, accompanied by sweating, dizziness and lower abdominal pain at 13 weeks of gestation. DIAGNOSES Blood analysis revealed anemia. Ultrasonography and plain computed tomography scan revealed intrauterine early pregnancy with effusion in pelvic and abdominal cavity. Laparotomy confirmed the diagnosis of UR. INTERVENTIONS The patient underwent emergency laparotomy. Upon surgery, multiple myometrium was weak with only serosal layer visible, and there was a 2.5 cm irregular breach with exposed placenta and villous tissue in the posterior wall of the uterus. After removing intrauterine fetus and repairing the breach, there was still persistent intraperitoneal hemorrhage. The patient underwent subtotal hysterectomy finally. OUTCOMES Postoperative recovery was uneventful. The patient was discharged on the 8th day after operation. LESSONS Combined efforts of specialists from ultrasound, imaging and gynecologist led to the successful diagnosis and management of this patient. We should be cautious about the occurrence of unscarred uterus rupture during pregnancy of the women with the disease of SLE and long-term glucocorticoid treatment. In IVF, we had better transfer one embryo for these patients with the history of SLE. Obstetricians should strengthen labor tests to detect early signs of UR of the patients with SLE and long term glucocorticoid treatment. Once UR is suspected, prompt surgical treatment is needed as soon as possible.
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Affiliation(s)
- Juan Zheng
- Reproductive Medicine Center, Ningbo Women and Children’s Hospital, Ningbo City, Zhejiang Province, China
| | - Liming Zhou
- Reproductive Medicine Center, Ningbo Women and Children’s Hospital, Ningbo City, Zhejiang Province, China
| | - Juwei Hu
- Reproductive Medicine Center, Ningbo Women and Children’s Hospital, Ningbo City, Zhejiang Province, China
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Sgayer I, Dabbah S, Farah RK, Wolf M, Ashkar N, Lowenstein L, Odeh M. Spontaneous Rupture of the Unscarred Uterus: A Review of the Literature. Obstet Gynecol Surv 2023; 78:759-765. [PMID: 38134341 DOI: 10.1097/ogx.0000000000001205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Importance Uterine rupture is defined as a nonsurgical disruption of all layers of the uterus. Most ruptures occur in the presence of a scar, usually secondary to a previous cesarean delivery. Rupture of an unscarred uterus is rare and is associated with severe maternal and neonatal outcomes. Objective To outline the literature on potential predisposing factors, clinical findings, and maternal and fetal outcomes of a rupture of an unscarred uterus. Evidence Acquisition PubMed was searched for the phrases "uterine rupture," "unscarred," and "spontaneous." Individual case reports, retrospective case series, and review articles in English between 1983 and 2020 were included. Results We found 84 case reports in 79 articles. The mean maternal age was 29.3 (SD, 5.7) years; 38 women (45.2%) were nulliparous. Uterine rupture occurred in 37% of the women at term; in 9.9%, the gestational age was ≤12 weeks. The most common clinical presentations were abdominal pain (77.4%), signs of hypovolemic shock (36.9%), fetal distress (31%), and vaginal bleeding (22.6%). The most common risk factors were the use of uterotonic drugs for induction or augmentation of labor and a prior curettage procedure. The most frequently ruptured site was the body of the uterus. Hysterectomy managed 36.9% of the ruptures. Four women died (4.8%). Perinatal mortality was 50.6%. Perinatal death was higher in developing than developed countries. Conclusions and relevance Although rare, spontaneous rupture of the unscarred uterus has serious consequences to the mother and the fetus and should be included in the differential diagnosis of acute abdomen in pregnancy.
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Affiliation(s)
- Inshirah Sgayer
- Head of Maternal and Fetal Clinic, Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya; Clinical Lecturer, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Shirin Dabbah
- Medical Student, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Rola Khamisy Farah
- Clalit Health Service, Akko, Senior Lecturer, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Maya Wolf
- Head of Maternal and Fetal Medicine Unit, Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya; Senior Lecturer, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Nadine Ashkar
- Resident of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Galilee Medical Center
| | - Lior Lowenstein
- Head of Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya; Associate Clinical Professor, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Marwan Odeh
- Associate Clinical Professor, Azrieli Faculty of Medicine, Bar Ilan University, Safed; Head of Obstetrical Ultrasound Unit, Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
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Ishikawa H, Saito Y, Koga K, Shozu M. Reproductive outcomes following abdominal repair for cesarean scar defect in women who desire subsequent pregnancies: A single-center retrospective study. Eur J Obstet Gynecol Reprod Biol 2023; 291:141-147. [PMID: 37871351 DOI: 10.1016/j.ejogrb.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/22/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE To clarify the reproductive outcomes of women who underwent abdominal repair surgery for cesarean scar defect (CSD). STUDY DESIGN This is a retrospective observational study performed in a tertiary center. We retrospectively reviewed 20 women who underwent abdominal repair between 2007 and 2021. The indication for the repair was a minimal residual myometrial thickness (RMT) of ≦3.0 mm. We investigated surgical complications, changes in minimal RMT before and three-months after the repair, and reproductive outcomes. RESULTS The median age at the time of repair was 36 years (27-40), with a median body mass index of 21.0 (17.7-28.7) and a median of 1 prior cesarean section (1-5). Twelve women reported secondary infertility, while eight women were concerned about the potential risk of uterine rupture in future pregnancies due to thin RMT. Additionally, one woman had a co-existing vesicouterine fistula, two had abscess and hematoma formation at the precedent cesarean section, and three showed remarkable dehiscence of the defect. The median minimal RMT significantly increased to 5.05 mm (range; 2.5-14.2 mm) after the repair. Seven women had a total of eight live births, with a median duration from the repair to a live-birth pregnancy of 11.5 months (range; 4-20 months). No surgical complications occurred during the repair, and there were no instances of uterine rupture in subsequent pregnancies. However, one woman who became pregnant with twins following double blastocyst transfer required a cesarean section at 25 weeks of pregnancy due to bulging towards the bladder side of the repaired CSD. CONCLUSION Abdominal repair for CSD is feasible in women with thin RMT who experience secondary infertility. Twin pregnancies can promote thinning of the CSD repair site, potentially increasing the risk of uterine rupture.
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Affiliation(s)
- Hiroshi Ishikawa
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Yoshiko Saito
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kaori Koga
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan; Evolution and Reproductive Biology, Medical Mycology Research Center, Chiba University, Chiba, Japan
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Van Mieghem T, Smith MK, Murji A. Laparoscopic repair of uterine dehiscence after open maternal-fetal surgery. Am J Obstet Gynecol 2023; 229:686-687. [PMID: 37148959 DOI: 10.1016/j.ajog.2023.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/01/2023] [Accepted: 04/29/2023] [Indexed: 05/08/2023]
Affiliation(s)
- Tim Van Mieghem
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada; Fetal Medicine Unit and Ontario Fetal Center, Mount Sinai Hospital, Toronto, Canada
| | - Martha K Smith
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| | - Ally Murji
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
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28
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Cai X, Fu Y, Hong K, Zhou Y, Qi G. Cornual pregnancy rupture and massive hemorrhage: A case report. Medicine (Baltimore) 2023; 102:e36383. [PMID: 38050207 PMCID: PMC10695607 DOI: 10.1097/md.0000000000036383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Corneal pregnancy is rare and difficult to detect in the early stages. Due to the abundant blood supply in this area, a rupture can result in massive internal bleeding, shock, and even death. Therefore, immediate surgery is necessary, and patients must replenish their blood volume as soon as possible to ensure blood supply to important organs. For those whose blood pressure cannot immediately rise, surgery should be performed while resisting shock to buy time. CASE SUMMARY We present the case of a 34-year-old Chinese woman at 19 weeks of gestation who had a corneal pregnancy. No abnormalities were detected in the examinations in the first trimester. This patient was 19 weeks pregnant and sought medical advice due to sudden lower abdominal pain, syncope, and hemorrhagic shock. After rescue and treatment, she recovered and was discharged from the hospital, afterwards, the patient gave birth to a child 7 years later. CONCLUSION The early diagnosis of cornual pregnancy is mainly based on ultrasound. However, there is a high incidence of missed diagnosis and misdiagnosis of this disease. Patients may face serious and life-threatening conditions in case of the rupture of cornual pregnancy. This disease can be mainly treated by surgery.
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Affiliation(s)
- Xiaqin Cai
- Department of Obstetrics and Gynecology, Tongde Hospital of Zhejiang Province (Zhijiang Branch District), Hangzhou, China
| | - Yizhou Fu
- Department of Obstetrics and Gynecology, Tongde Hospital of Zhejiang Province (Zhijiang Branch District), Hangzhou, China
| | - Ke Hong
- Department of Obstetrics and Gynecology, Tongde Hospital of Zhejiang Province (Zhijiang Branch District), Hangzhou, China
| | - Yuefang Zhou
- Department of Obstetrics and Gynecology, Tongde Hospital of Zhejiang Province (Zhijiang Branch District), Hangzhou, China
| | - Guangju Qi
- Department of Obstetrics and Gynecology, Tongde Hospital of Zhejiang Province (Zhijiang Branch District), Hangzhou, China
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Lopian M, Kashani-Ligumski L, Cohen R, Herzlich J, Vinnikov Y, Perlman S. Grand multiparity, is it a help or a hindrance in a trial of labor after cesarean section (TOLAC)? J Matern Fetal Neonatal Med 2023; 36:2190835. [PMID: 36935374 DOI: 10.1080/14767058.2023.2190835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
OBJECTIVE Parity is a prognostic variable when considering trial of labor after cesarean section (TOLAC). This study aimed to determine whether grandmultiparous patients are at increased risk of poor TOLAC outcomes such as uterine rupture. STUDY DESIGN A retrospective cohort was conducted at a single university-affiliated medical center with approximately 10,000 deliveries per year. The study group included women post one cesarean section who attempted TOLAC carrying a singleton fetus in vertex presentation. We divided the cohort into three groups: group 1 - women who had a parity of 1; group 2 - parity of 2-4; group 3 - parity of 5 and above. The primary outcome was successful VBAC. Secondary outcomes included mode of delivery, uterine rupture, and combined maternal and neonatal adverse outcomes. Data were analyzed using Fisher's exact test, Chi-square test, ANOVA, and paired t-test. RESULTS Five thousand four hundred and forty-seven women comprised the study group: group 1 - 879 patients, group 2 - 2374 patients, and group 3 - 2194 patients. No significant between-group differences were found in gestational age at delivery. Rates of a successful VBAC were 80.6%, 95.4%, and 95.5%, respectively. Group 1 were more likely to have a failed TOLAC compared to group 2 (OR 5.02, 95% CI 3.9-6.5, p<.001) and group 3 (OR 5.17, 95% CI 4.0-6.7, p<.001). There was no increased risk of failed TOLAC when comparing groups 2 and 3 (OR 1.03; 95% CI 0.8-1.4, p=.89). Operative delivery rate differed significantly between all three groups; 25.1%, 6.2%, and 3.6%, for groups 1, 2, and 3, respectively (p<.001). The rate of uterine rupture was significantly higher in group 1 compared to group 2 (1.02% vs. 0.29% p=.02) and group 3 (1.02% vs. 0.2%, p=.01, respectively). There were no differences between group 2 and group 3 (0.29% vs. 0.2% p=.78). CONCLUSIONS Grandmultiparity is not associated with an increased risk of uterine rupture during TOLAC.
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Affiliation(s)
- Miriam Lopian
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Kashani-Ligumski
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronnie Cohen
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacky Herzlich
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
- Department of Neonatology, Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yana Vinnikov
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Perlman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
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Sugai S, Yamawaki K, Haino K, Yoshihara K, Nishijima K. Incidence of Recurrent Uterine Rupture: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 142:1365-1372. [PMID: 37884008 PMCID: PMC10642701 DOI: 10.1097/aog.0000000000005418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE We aimed to quantify the incidence of recurrent uterine rupture in pregnant women. DATA SOURCES A literature search of PubMed, Web of Science, Cochrane Central, and ClinicalTrials.gov for observational studies was performed from 2000 to 2023. METHODS OF STUDY SELECTION Of the 7,440 articles screened, 13 studies were included in the final review. We included studies of previous uterine ruptures that were complete uterine ruptures , defined as destruction of all uterine layers, including the serosa. The primary outcome was the pooled incidence of recurrent uterine rupture. Between-study heterogeneity was assessed with the I2 value. Subgroup analyses were conducted in terms of the country development status, year of publication, and study size (single center vs national study). The secondary outcomes comprised the following: 1) mean gestational age at which recurrent rupture occurred, 2) mean gestational age at which delivery occurred without recurrent rupture, and 3) perinatal complications (blood loss, transfusion, maternal mortality, and neonatal mortality). TABULATION, INTEGRATION, AND RESULTS A random-effects model was used to pool the incidence or mean value and the corresponding 95% CI with R software. The pooled incidence of recurrent uterine rupture was 10% (95% CI 6-17%). Developed countries had a significantly lower uterine rupture recurrence rate than less developed countries (6% vs 15%, P =.04). Year of publication and study size were not significantly associated with recurrent uterine rupture. The mean number of gestational weeks at the time of recurrent uterine rupture was 32.49 (95% CI 29.90-35.08). The mean number of gestational weeks at the time of delivery without recurrent uterine rupture was 35.77 (95% CI 34.95-36.60). The maternal mortality rate was 5% (95% CI 2-11%), and the neonatal mortality rate was 5% (95% CI 3-10%). Morbidity from hemorrhage, such as bleeding and transfusion, was not reported in any study and could not be evaluated. CONCLUSION This systematic review estimated a 10% incidence of recurrent uterine rupture. This finding will enable appropriate risk counseling in patients with prior uterine rupture. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42023395010.
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Affiliation(s)
- Shunya Sugai
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
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31
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Celik HG, Celik E, Buyru F, Bastu E. Cornual Pregnancy Reaching Eight Weeks of Gestation without Uterine Rupture. J Minim Invasive Gynecol 2023; 30:857-858. [PMID: 37422050 DOI: 10.1016/j.jmig.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Hale Goksever Celik
- Department of Obstetrics and Gynecology, Acibadem Mehmet Ali Aydinlar University, Faculty of Medicine, Acibadem Fulya Hospital, Istanbul, Turkey.
| | - Engin Celik
- Department of Gynecologic Oncology, University of Health Sciences, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Faruk Buyru
- Department of Obstetrics and Gynecology, Acibadem Fulya Hospital, Istanbul, Turkey
| | - Ercan Bastu
- Department of Obstetrics and Gynecology, Biruni University, Istanbul, Turkey
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Mercier M, Meneu A, Tesson C, Lassel L, Le Lous M, Enderle I. Retrospective evaluation of labor induction with scar uterus at the university hospital of Rennes. J Gynecol Obstet Hum Reprod 2023; 52:102641. [PMID: 37595753 DOI: 10.1016/j.jogoh.2023.102641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE The aim of the study was a retrospective evaluation of labor induction in women with one previous cesarean section. The primary outcome was the mode of delivery. We also studied the severe maternal and neonatal morbidity and identify some prediction factors of vaginal delivery after labor induction after one previous cesarean section. STUDY DESIGN This was a retrospective observational monocentric study performed over the period from January 1st, 2016 to April 30th, 2020 at the university hospital of Rennes. Were included women with scar uterus because of one previous cesarean section with a viable singleton fetus in cephalic presentation and an induction of labor for medical reason, at term. Multivariate logistic regression analysis was used to analyze prediction of vaginal delivery after labor induction after one previous cesarean section. We also studied maternal (included uterine rupture, loss of blood, obstetrical injury of anus sphincter) and neonatal (APGAR score, arterial umbilical pH after 1 minute of life and eventual admission to neonatal unit) morbidity. We used a stepwise multivariate logistic regression model to select variables for multivariate analysis. The model with the lowest Akaike Index Criteria was chosen. RESULTS The study enrolled 353 women with scar uterus: 121 women were induced by balloon catheter, 57 by osmotic cervical dilatators, 91 by oxytocin alone, 84 by amniotomy. Vaginal delivery rate was 47,9%. There was 45% of vaginal delivery in the group with Bishop < 6 before induction of labor versus 62% in the group with Bishop ≥ 6. There was no statistically significative difference in neonatal and maternal severe morbidities between vaginal delivery and cesarean section: 4,5% of severe maternal morbidities (n = 16). Among their, we highlighted 7 uterine ruptures (3,8%). We observed also 3% of postpartum severe hemorrhage in vaginal delivery group (n = 5) against 1,6% in cesarian section group (n = 3) with no statistical significant difference (p = 0,632). Regarding to the obstetric perineal tears and lacerations we noticed 1,2% of OASIS 3 (n = 2) and 0,6% of OASIS 4 (n = 1). Severe neonatal morbidities were comparable by mode of delivery without significant difference: APGAR score at 5 min was similar (p = 1), as well as arterial umbilical pH after 1 min. (p = 0.719) and admissions to a neonatal unit (p = 1). Two variables were statistically associated with vaginal delivery after labor induction in women with scar uterus: Bishop score ≥ 6 (OR = 0,44; 95%CI: 0,25-0,81) and/or previous vaginal delivery after cesarean section (OR = 0,17; 95%CI: 0,08-0,35). CONCLUSION With 47,9% of vaginal delivery after labor induction in women with scar uterus, only 3.8% (n = 7/353) of uterine ruptures, less than 1% APGAR < 7 at 5 min (n = 3/353), induction on scar uterus should be consider in obstetrical practice. Bishop score ≥ 6 and/or previous vaginal delivery after cesarean section are associated to vaginal delivery after labor induction.
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Affiliation(s)
- Marion Mercier
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France.
| | - Alisée Meneu
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
| | - Caroline Tesson
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
| | - Linda Lassel
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
| | - Maela Le Lous
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
| | - Isabelle Enderle
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
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Lauterbach R, Justman N, Ginsberg Y, Siegler Y, Bachar G, Vitner D, Ben-David C, Zipori Y, Beloosesky R, Weiner Z, Khatib N. The impact of extending the second stage of labor on repeat cesarean section and maternal and neonatal outcome. Int J Gynaecol Obstet 2023; 163:594-600. [PMID: 37177788 DOI: 10.1002/ijgo.14855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/23/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To evaluate the effects of extending the second stage of labor in women attempting a trial of labor after a cesarean section (TOLAC). METHOD A retrospective cohort study comparing maternal and neonatal outcomes following TOLAC over two periods: period I whose prolonged second stage was considered 2 h, and period II whose prolonged second stage was considered 3 h. The primary outcome was repeat cesarean delivery (CD) rate. RESULTS Incidence of repeat CD was significantly lower in period II (18.1% vs 29.7%, P < 0.001). Incidence of uterine rupture was significantly higher in period II (P < 0.001). Instrumental delivery rates were significantly higher in period II (26.2% vs 15.6%, odds ratio [OR] 1.67, 95% CI 1.21-3.56, P < 0.001). Rates of third- and fourth-degree perineal lacerations, chorioamnionitis, and length of hospital stay were similar between groups. Incidence of fetal acidemia was significantly higher in period II (1.5% vs 0.7%, OR 2.14, 95% CI 1.32-5.63, P < 0.001), and incidence of neonatal intensive care unit (NICU) admission was significantly higher (2.5% vs 1.6%, P = 0.004). CONCLUSION Extension of the second stage of labor is associated with a decrease in repeat CD rate with a concomitant increase in instrumental delivery rates, uterine rupture, fetal acidemia, and NICU admissions. These findings may warrant further consideration of allowing a prolonged second stage in patients attempting TOLAC.
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Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yoav Siegler
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Gal Bachar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Chen Ben-David
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Vandenberghe G, Vierin A, Bloemenkamp K, Berlage S, Colmorn L, Deneux-Tharaux C, Donati S, Gissler M, Knight M, Langhoff-Roos J, Lindqvist PG, Maier B, van Roosmalen J, Zwart J, Roelens K. Incidence and outcomes of uterine rupture in women with unscarred, preterm or prelabour uteri: data from the international network of obstetric survey systems. BJOG 2023; 130:1493-1501. [PMID: 37113103 DOI: 10.1111/1471-0528.17517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE Analysis of atypical cases of uterine rupture, namely, uterine rupture occurring in unscarred, preterm or prelabour uteri. DESIGN Descriptive multi-country population-based study. SETTING Ten high-income countries within the International Network of Obstetric Survey Systems. POPULATION Women with unscarred, preterm or prelabour ruptured uteri. METHODS We merged prospectively collected individual patient data in ten population-based studies of women with complete uterine rupture. In this analysis, we focused on women with uterine rupture of unscarred, preterm or prelabour ruptured uteri. MAIN OUTCOME MEASURES Incidence, women's characteristics, presentation and maternal and perinatal outcome. RESULTS We identified 357 atypical uterine ruptures in 3 064 923 women giving birth. Estimated incidence was 0.2 per 10 000 women (95% CI 0.2-0.3) in the unscarred uteri, 0.5 (95% CI 0.5-0.6) in the preterm uteri, 0.7 (95% CI 0.6-0.8) in the prelabour uteri, and 0.5 (95% CI 0.4-0.5) in the group with no previous caesarean. Atypical uterine rupture resulted in peripartum hysterectomy in 66 women (18.5%, 95% CI 14.3-23.5%), three maternal deaths (0.84%, 95% CI 0.17-2.5%) and perinatal death in 62 infants (19.7%, 95% CI 15.1-25.3%). CONCLUSIONS Uterine rupture in preterm, prelabour or unscarred uteri are extremely uncommon but were associated with severe maternal and perinatal outcome. We found a mix of risk factors in unscarred uteri, most preterm uterine ruptures occurred in caesarean-scarred uteri and most prelabour uterine ruptures in 'otherwise' scarred uteri. This study may increase awareness among clinicians and raise suspicion of the possibility of uterine rupture under these less expected conditions.
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Affiliation(s)
- Griet Vandenberghe
- Department of Obstetrics & Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Anne Vierin
- Department of Obstetrics & Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Kitty Bloemenkamp
- Department of Obstetrics and Gynaecology, Birth Centre Wilhelmina's Children's Hospital, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Sylvia Berlage
- Centre for Quality and Management in Health Care, Medical Association of Lower Saxony, Hannover, Germany
| | - Lotte Colmorn
- Department of Obstetrics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Catherine Deneux-Tharaux
- Université Paris Cité, Obstetrics, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics, Paris, France
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità (Italian National Institute of Health), Rome, Italy
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Academic Primary Health Care Centre, Stockholm, Sweden
| | - M Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Jens Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Pelle G Lindqvist
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
- Department of Obstetrics and Gynaecology, Stockholm, Sweden
| | - Barbara Maier
- Department of Gynaecology and Obstetrics, Clinic Ottakring, Vienna Healthcare Group, Vienna, Austria
| | - Jos van Roosmalen
- Athena Institute, VU University Amsterdam, Amsterdam, the Netherlands
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Joost Zwart
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, the Netherlands
| | - Kristien Roelens
- Department of Obstetrics & Gynaecology, Ghent University Hospital, Ghent, Belgium
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Madhuri MS, Jha N, Pampapati V, Chaturvedula L, Jha AK. Fetomaternal outcome of scarred uterine rupture compared with primary uterine rupture: a retrospective cohort study. J Perinat Med 2023; 51:1067-1073. [PMID: 37125850 DOI: 10.1515/jpm-2023-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Literature comparing maternal and perinatal outcomes among women with scarred and primary uterine rupture are limited. Therefore, the study aimed to compare maternal and perinatal outcomes and associated risk factors of uterine rupture among scarred and unscarred uterus. METHODS This retrospective cohort study was performed at a large tertiary care of India between July 1, 2011 and June 30, 2020. We analysed all the cases of complete uterine rupture beyond the 20th week of gestation. The outcome measures were live birth rate, perinatal mortality, maternal mortality and morbidity. RESULTS A total of 115 complete uterine ruptures were noted in 148,102 pregnancies. Of those 115 uterine ruptures, 89 (77.3 %) uterine ruptures occurred in women with a history of caesarean delivery, and 26 (22.6 %) uterine ruptures occurred in primary uterine rupture. The primary uterine rupture group had a significantly higher incidence of lower parity, breech presentation and mean birth weight. The live birth rate (68.18% vs. 42.85 %; p=0.04) was significantly higher in the scarred group, and the stillbirth rate (57.14% vs. 31.86 %; p=0.009) was significantly higher in the primary uterine rupture group. Hypoxic ischemic encephalopathy, APGAR score, and neonatal intensive care unit admission were comparable. Postpartum haemorrhage, blood transfusion, severe acute maternal morbidity and intensive care unit stay were more frequently reported in the primary uterine rupture group. CONCLUSIONS The maternal and perinatal outcomes appear less favourable among women with primary uterine rupture than scarred uterine rupture.
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Affiliation(s)
- Makkam S Madhuri
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Nivedita Jha
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Veena Pampapati
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Latha Chaturvedula
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Ajay Kumar Jha
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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Finnsdottir SK, Maghsoudlou P, Pepin K, Gu X, Carusi DA, Einarsson JI, Rassier SLC. Uterine rupture and factors associated with adverse outcomes. Arch Gynecol Obstet 2023; 308:1271-1278. [PMID: 36271922 DOI: 10.1007/s00404-022-06820-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/08/2022] [Indexed: 11/30/2022]
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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Affiliation(s)
- Stefania K Finnsdottir
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, US
| | - Parmida Maghsoudlou
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, US
| | - Kristen Pepin
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, US
| | - Xiangmei Gu
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, US
| | - Daniela A Carusi
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, US
| | - Jon I Einarsson
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, US
| | - Sarah L Cohen Rassier
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, US.
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Peled T, Ashwal E, Rotem R, Sela HY, Grisaru-Granovsky S, Rottenstreich M. Unintended lower-segment hysterotomy extension at cesarean delivery and the risk for uterine rupture during a subsequent trial of labor. Int J Gynaecol Obstet 2023; 162:957-963. [PMID: 37074521 DOI: 10.1002/ijgo.14785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/12/2023] [Accepted: 03/28/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To evaluate the association between unintended uterine extension in cesarean delivery and uterine scar disruption (rupture or dehiscence) at the subsequent trial of labor after cesarean delivery (TOLAC). METHODS This is a multicenter retrospective cohort study (2005-2021). Parturients with a singleton pregnancy who had unintended lower-segment uterine extension during the primary cesarean delivery (excluding T and J vertical extensions) were compared with patients who did not have an unintended uterine extension. We assessed the subsequent uterine scar disruption rate following the subsequent TOLAC and the rate of adverse maternal outcome. RESULTS During the study period, 7199 patients underwent a trial of labor and were eligible for the study, of whom 1245 (17.3%) had a previous unintended uterine extension and 5954 (82.7%) did not. In univariate analysis, previous unintended uterine extension during the primary cesarean delivery was not significantly associated with uterine scar rupture in the following subsequent TOLAC. Nevertheless, it was associated with uterine scar dehiscence, higher rates of TOLAC failure, and a composite adverse maternal outcome. In multivariate analyses, only the association between previous unintended uterine extension and higher rates of TOLAC failure was confirmed. CONCLUSION A history of unintended lower-segment uterine extension is not associated with an increased risk for uterine scar disruption following subsequent TOLAC.
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Affiliation(s)
- Tzuria Peled
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Eran Ashwal
- Department of Obstetrics and Gynecology, McMaster University Medical Center, McMaster University, Hamilton, Ontario, Canada
| | - Reut Rotem
- Department of Obstetrics and Gynecology, McMaster University Medical Center, McMaster University, Hamilton, Ontario, Canada
| | - Hen Y Sela
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
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Komatsu H, Taniguchi F, Harada T. Impact of myomectomy on the obstetric complications: A large cohort study in Japan. Int J Gynaecol Obstet 2023; 162:977-982. [PMID: 36998147 DOI: 10.1002/ijgo.14767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/17/2023] [Accepted: 03/11/2023] [Indexed: 04/01/2023]
Abstract
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.
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Affiliation(s)
- Hiroaki Komatsu
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Tottori, Japan
| | - Fuminori Taniguchi
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Tottori, Japan
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Nardi E, Seravalli V, Abati I, Castiglione F, Di Tommaso M. Antepartum unscarred uterine rupture caused by placenta percreta: a case report and literature review. Pathologica 2023; 115:232-236. [PMID: 37711040 PMCID: PMC10688248 DOI: 10.32074/1591-951x-882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 09/16/2023] Open
Abstract
The main risk for uterine rupture is the presence of a uterine scar due to prior cesarean delivery or other uterine surgery. However, rupture in an unscarred uterus is extremely rare, and risk factors include multiple gestations, trauma, congenital anomalies, use of uterotonics and placenta accreta spectrum. Placenta accreta spectrum, also known as morbidly adherent placenta, is becoming increasingly common and is associated with significant maternal and neonatal morbidity and mortality. We report a case of unscarred uterine rupture due to placenta percreta in a multiparous woman that required emergency peripartum hysterectomy.
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Affiliation(s)
- Eleonora Nardi
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Viola Seravalli
- Department of Health Science, Division of Obstetrics & Gynecology, University of Florence, Florence, Italy
| | - Isabella Abati
- Department of Health Science, Division of Obstetrics & Gynecology, University of Florence, Florence, Italy
| | - Francesca Castiglione
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Mariarosaria Di Tommaso
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
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Chen Y, Cao Y, She JY, Chen S, Wang PJ, Zeng Z, Liang CY. Spontaneous rupture of an unscarred uterus during pregnancy: A rare but life-threatening emergency: Case series. Medicine (Baltimore) 2023; 102:e33977. [PMID: 37327264 PMCID: PMC10270498 DOI: 10.1097/md.0000000000033977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/22/2023] [Indexed: 06/18/2023] Open
Abstract
RATIONALE In most cases, uterine rupture occurs during the third trimester of pregnancy or during labor. Even fewer reports have been published about the occurrence of this condition without a gynecologic history of any surgical procedure. Due to their scarcity and variable clinical presentation, early diagnosis of uterine rupture may be difficult, and if the diagnosis is not timely, the condition may be life-threatening. PATIENT CONCERNS Herein, 3 cases of uterine rupture from a single institution are described. Three patients are at different gestational weeks and all have no history of uterine surgery. They came to the hospital due to acute abdominal pain, which is characterized by severe and persistent pain in the abdomen, with no apparent vaginal bleeding. DIAGNOSES All 3 patients were diagnosed with uterine rupture during the operation. INTERVENTIONS One patient underwent uterine repair surgery; while the other 2 underwent subtotal hysterectomy due to persistent bleeding and pathological examination after surgery confirmed placenta implantation. OUTCOMES The patients recovered well after the operation, and no discomfort occurred in the follow-up. LESSONS Acute abdominal pain during pregnancy can pose both diagnostic and therapeutic challenges. It is important to consider the possibility of uterine rupture, even in cases where there is no history of prior uterine surgery. The key to the treatment of uterine rupture is to shorten the diagnosis time as much as possible, this potential complication should be carefully monitored for and promptly addressed to ensure the best possible outcomes for both the mother and the developing fetus.
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Affiliation(s)
- Yue Chen
- The Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
- Department of Obstetrics and Gynecology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing Jiangsu, China
- Department of Obstetrics and Gynecology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Ying Cao
- Department of Obstetrics and Gynecology, Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Jing-Yao She
- The Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Si Chen
- Department of Obstetrics and Gynecology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing Jiangsu, China
- Department of Obstetrics and Gynecology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Pei-Juan Wang
- Department of Obstetrics and Gynecology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing Jiangsu, China
- Department of Obstetrics and Gynecology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Zheng Zeng
- Department of Pathology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Chun-Yun Liang
- The Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
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Mansoux L, Lejeune-Saada V, Dupuis N, Guerby P. [Uterine rupture during medical termination of pregnancy or intrauterine death: A risk management study]. Gynecol Obstet Fertil Senol 2023; 51:331-336. [PMID: 36931596 DOI: 10.1016/j.gofs.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/01/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE To describe and analyze a series of uterine ruptures (UR) that occurred in the context of medical termination of pregnancy (MTP) or intrauterine death (IUD) from a risk management perspective. METHODS French retrospective descriptive observational study of all cases of UR occurring during induction for IUD or MTP, reported between 2011 and 2021 by Gynerisq. Cases were recorded on a basis of voluntary reports using targeted questionnaires. RESULTS Between November 27, 2011, and August 22, 2021, 12 cases of UR occurring during an induction for IUD or MTP were recorded. 50 % of the patients had never given birth by cesarean section. The term of delivery varied from 17+3 days to 41+2 days. The clinical signs found were pain (n=6), ascending fetal presentation (n=5) and bleeding (n=4). All patients were managed by laparotomy, 5 were transfused. One vascular ligation and one hysterectomy were required. CONCLUSION Knowledge of surgical history is involved in the prevention of UR. The signs of detection are pain, ascending presentation and bleeding. The speed of management and good teamwork allow a reduction of maternal complications. The findings of the morbidity and mortality reviews show that prevention and mitigation barriers can be established.
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Affiliation(s)
- Lucile Mansoux
- CHU Toulouse, Pôle Femme Mère Couple, hôpital Paule de Viguier, 31059 Toulouse, France; Université Paul Sabatier Toulouse III, 31330 Toulouse, France.
| | | | - Ninon Dupuis
- CHU Toulouse, Pôle Femme Mère Couple, hôpital Paule de Viguier, 31059 Toulouse, France; Université Paul Sabatier Toulouse III, 31330 Toulouse, France
| | - Paul Guerby
- CHU Toulouse, Pôle Femme Mère Couple, hôpital Paule de Viguier, 31059 Toulouse, France; Université Paul Sabatier Toulouse III, 31330 Toulouse, France
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Kawakami K, Yoshizato T, Kurokawa Y, Okura N, Ushijima K. New ultrasonographic risk assessment of uterine scar dehiscence in pregnancy after cesarean section. J Med Ultrason (2001) 2023; 50:89-96. [PMID: 36536061 DOI: 10.1007/s10396-022-01265-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/14/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE We performed a new ultrasonographic risk assessment of uterine scar dehiscence, which is a potential risk factor for uterine rupture, in pregnancy after cesarean section. We attempted to shed light on the natural course of the change in the lower uterine segment by means of a longitudinal investigation through quantitative and qualitative evaluations. METHODS This retrospective single-center study involved 31 women with a normal singleton pregnancy delivered by elective cesarean section between 2020 and 2021, with all women showing a "niche" in the lower uterine segments. The lower uterine segments were assessed qualitatively and quantitatively using transvaginal ultrasonography at 16-21, 22-27, and 28-33 weeks of gestation, and subjects were divided into two groups: those with uterine dehiscence (12 women) and those without uterine dehiscence (19 women), depending on the gross findings of the lower uterine segments at cesarean section. Analyses were performed using Wilcoxon's rank-sum and Mann-Whitney U test with a significance level of P < 0.05. RESULTS The lower uterine segments changed from V-shaped to U-shaped to thin as gestation progressed and was more prominent in the uterine dehiscence group, occurring mostly at 22-27 weeks. At 22-27 weeks, the median myometrial thickness in the uterine dehiscence group was lower than in the group without uterine dehiscence (P = 0.0030). Thinning of the lower uterine segments had moved the cephalad at 22-27 and 28-33 weeks in cases with and without uterine dehiscence. CONCLUSION A model of morphological changes in the niche was constructed based on qualitative and quantitative assessments. The morphological changes and actual thinning of the lower uterine segments were prominent in the second trimester in women considered to have uterine scar dehiscence.
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Affiliation(s)
- Kosuke Kawakami
- Department of Obstetrics and Gynecology, National Hospital Organization Kokura Medical Center, Kitakyushu, Japan
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Toshiyuki Yoshizato
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, 67 Asahi-machi, Kurume, 830-0011, Japan.
| | - Yusuke Kurokawa
- Department of Obstetrics and Gynecology, National Hospital Organization Kokura Medical Center, Kitakyushu, Japan
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Naofumi Okura
- Department of Obstetrics and Gynecology, National Hospital Organization Kokura Medical Center, Kitakyushu, Japan
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, 67 Asahi-machi, Kurume, 830-0011, Japan
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Yang SW, Yoon SH, Yuk JS, Chun KC, Jeong MJ, Kim M. Rupture-mediated large uterine defect at 30th gestational week with protruded amniotic sac and fetal head without fetal compromise after laparoscopic electromyolysis: Case report and literature review. Medicine (Baltimore) 2022; 101:e32221. [PMID: 36595794 PMCID: PMC9794237 DOI: 10.1097/md.0000000000032221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND We describe a case of a rupture-mediated large uterine defect, which occurred on the 30th gestation week presenting a protruding amniotic sac sac without fetal compromise after a laparoscopic electromyolysis. CASE PRESENTATION A 28-year-old woman in her 30th week of gestation (gravida 2, para 0) presented with whole abdominal and right lower quadrant pain at Sanggye Paik Hospital. Ultrasound examination showed normal amniotic fluid and placentation but with breech presentation. She had undergone laparoscopic right ovarian cystectomy due to endometriosis 5 years earlier. Cardiotocography revealed an intermittent variable deceleration and no uterine contraction. Magnetic resonance imaging ruled out acute appendicitis. Four hours later, we observed a protrusion of the amniotic sac with the fetal head through a large uterine defect on magnetic resonance imaging, and performed emergency cesarean section. A boy was delivered without fetal compromise. During the cesarean section, multiple myometric wall defects and thinning were identified. After reconstruction of the uterine wall, the flaccid uterus bled persistently; thus, a cesarean hysterectomy was performed. Packed red cells and frozen plasma were transfused. The mother and neonate had uneventful puerperal and neonatal courses, respectively. After cesarean hysterectomy, we were informed that the mother had undergone a combined laparoscopic electromyolysis during the laparoscopic right ovarian cystectomy. Three years later, the child showed normal neural development. CONCLUSIONS Before myomectomy or electromyolysis, patients should be informed of the possibility of uterine rupture during subsequent pregnancies. If a pregnant woman has abdominal pain, clinicians should take a detailed history of uterine surgery and consider uterine rupture. Although, fortunately, the outcomes in this case were uneventful, urgent delivery is required when uterine rupture is diagnosed.
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Affiliation(s)
- Seung-Woo Yang
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of South Korea
| | - Sang-Hee Yoon
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of South Korea
| | - Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of South Korea
| | - Kyoung-Chul Chun
- Department of Obstetrics and Gynecology, Inje University College of Medicine, Ilsan-Paik Hospital, Gyeonggi, South Korea
| | - Myeong Ja Jeong
- Department of Radiology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of South Korea
| | - Myounghwan Kim
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of South Korea
- * Correspondence: Myounghwan Kim, Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, 1342, Dongil-ro, Nowon-gu, Seoul 01757, Republic of South Korea (e-mail: )
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44
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Lai THT, Seto MTY, Cheung VYT. Intrapartum uterine rupture following ultrasound-guided high-intensity focused ultrasound ablation of uterine fibroid and adenomyosis. Ultrasound Obstet Gynecol 2022; 60:816-817. [PMID: 35748875 DOI: 10.1002/uog.24983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/08/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Affiliation(s)
- T H T Lai
- Department of Obstetrics and Gynecology, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - M T Y Seto
- Department of Obstetrics and Gynecology, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - V Y T Cheung
- Department of Obstetrics and Gynecology, University of Hong Kong, Queen Mary Hospital, Hong Kong
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45
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Dellino M, Crupano FM, He X, Malvasi A, Vimercati A. Uterine rupture after previous caesarean section with hysterotomy above the lower uterine segment. Acta Biomed 2022; 93:e2022269. [PMID: 36129411 PMCID: PMC10510962 DOI: 10.23750/abm.v93is1.12872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/31/2022] [Indexed: 01/27/2023]
Abstract
Background Spontaneous uterine rupture is a severe pregnancy complication. Several risk factors have been described, especially for women with a previous caesarean section. Method We reported two cases of uterine rupture (UR) occurring outside of labour in patients with a history of caesarean section (CS) due to placenta previa. Results: The current study evaluates how a higher hysterotomy, combined with some risk factors, can increase the prevalence of UR in the subsequent pregnancy. Conclusion This study supports that a careful evaluation of risk factors can identify patients who need a specific follow up to early diagnose and treat UR and thus improve the maternal-fetal outcome.
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Affiliation(s)
- Miriam Dellino
- Department of Biomedical Sciences and Human Oncology, University of Bari, Italy.
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46
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Knudsen AKS, Botházi A. [Traumatic uterine rupture in gemelli pregnant woman causing emergency hysterectomy]. Ugeskr Laeger 2022; 184:V04220258. [PMID: 36178193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This is a case report of a 30-year-old gemelli pregnant woman in gestation week 15 and 6 days, who was admitted to a local hospital after being involved in a high impact motor vehicle accident. Traumatic uterine rupture was suspected and the patient was immediately operated with exploratory laparotomy. Emergency hysterectomy was performed, hence the pregnancy was terminated. This case is a rare obstetric trauma situation, and prompt diagnosis is life-saving.
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Affiliation(s)
- Ane-Kersti Skaarup Knudsen
- Kvindesygdomme og Fødsler, Regionshospitalet Viborg, Hospitalsenhed Midt
- Kvindesygdomme og Fødsler, Regionshospitalet Gødstrup, Hospitalsenhed Vest
| | - Attila Botházi
- Kvindesygdomme og Fødsler, Regionshospitalet Viborg, Hospitalsenhed Midt
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47
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Wang LL, Yang HX, Chen JY, Fan LX, Zhang XX. [Prediction and analysis of adverse pregnancy outcomes in pregnant women with cesarean scar diverticulum]. Zhonghua Fu Chan Ke Za Zhi 2022; 57:587-593. [PMID: 36008285 DOI: 10.3760/cma.j.cn112141-20220107-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To investigate the pregnancy outcomes of pregnant women with cesarean scar diverticulum (CSD) and to find the relevant factors that predict the occurrence of adverse pregnancy outcomes. Methods: From January 2015 to March 2019, 501 singleton pregnant women with a history of cesarean section who underwent regular prenatal examination in early pregnancy and eventually delivered in Peking University First Hospital were prospectively collected. According to the presence or absence of CSD in the first trimester of pregnancy, the pregnant women were divided into the CSD group (n=127, 25.3%) and the non-CSD group (n=374, 74.7%). According to the mode of delivery and the classification of the lower uterine segment seen during cesarean section, the CSD group was further divided into the non-rupture group (including spontaneous delivery and lower uterine segment grade Ⅰ;n=108, 85.0%) and rupture group (including lower uterine segment grade Ⅱ-Ⅳ;n=19, 15.0%). The general clinical data, pregnancy outcomes, diverticulum-related indexes [including length, width, depth (D), average diameter, volume, and residual myometrial thickness (RMT)] were compared. The predictive values of D/adjacent myometrial thickness≥50%, RMT≤2.2 mm and D/RMT>1.3 for uterine rupture in CSD pregnant women were verified. Results: (1) Comparison between CSD group and non-CSD group: the lower uterine segment thickness in the third trimester of pregnancy in the CSD group was lower than that in the non-CSD group [(1.2±0.5) vs (1.4±0.6) mm, respectively], and the incidence of uterine rupture was higher than that in the non-CSD group [15.0% (19/127) vs 8.0% (30/374), respectively], and the differences were statistically significant (both P<0.05). There were no significant differences in other clinical data and pregnancy outcomes between the two groups (all P>0.05). (2) Comparison of rupture group and non-rupture group: the lower uterine segment thickness in the third trimester of pregnancy in rupture group [(0.6±0.5) mm] was lower than that in non-rupture group [(1.2±0.6) mm], and the difference was statistically significant (t=3.486, P=0.001). There were no significant differences in diverticulum-related indexes between the two groups (all P>0.05). (3) Relationship between high risk predictors of uterine rupture and actual uterine rupture: the sensitivity of D/adjacent muscle thickness ≥50%, RMT≤2.2 mm and D/RMT>1.3 in predicting the high risk of uterine rupture were 94.7%, 57.9% and 73.6%, the specificity were 12.0%, 40.7% and 24.1%, the positive predictive value were 15.9%, 14.7%, 14.6%, and the negative predictive value were 92.8%, 84.6%, 83.9%, respectively. Conclusions: The risk of uterine rupture in pregnant women with CSD is higher than that in those without CSD. There is no significant correlation between CSD related indexes and uterine rupture in the first trimester. Monitoring the lower uterine segment thickness in the third trimester might be helpful to predict the occurrence of adverse pregnancy outcomes.
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Affiliation(s)
- L L Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - H X Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - J Y Chen
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - L X Fan
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - X X Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
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48
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Zhang DM, Wang YL, Liu WW, Xu LY, Chen SM. [Establish and application of scoring scale for trial of labor after cesarean section]. Zhonghua Fu Chan Ke Za Zhi 2022; 57:339-345. [PMID: 35658324 DOI: 10.3760/cma.j.cn112141-20220321-00180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To establish a scoring scale for trial of labor after cesarean section (TOLAC), to explore the evaluation ability of this scoring scale for vaginal delivery after cesarean section (VBAC), and to improve the success rate of TOLAC. Methods: The delivery information of 661 TOLAC pregnant women admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from 2014 to 2017 was retrospectively analyzed, and the TOLAC scoring scale was established by referring to relevant literatures. A prospective cohort study of pregnant women with TOLAC from January 2018 to December 2019 in Zhengzhou Central Hospital was conducted, including 440 pregnant women who were excluded from contraindications in trial labor. According to TOLAC scoring scale, pregnant women were divided into 3 groups, 0-6 group (94 cases), 7-9 group (234 cases) and 10-15 group (112 cases). The success rate of trial labor, failure reasons and incidence of maternal and neonatal complications were compared among the three groups. Results: (1) The overall success rate of TOLAC in 440 pregnant women was 75.0% (330/440). The success rates of 0-6, 7-9 and 10-15 groups were 53.2% (50/94), 76.9% (180/234) and 89.3% (100/112), respectively. The success rate of 10-15 group were significantly higher than those of 0-6 and 7-9 groups (all P<0.05). (2) Among the causes of trial labor failure, there were statistically significant differences between the three groups in terms of threatened uterine rupture and maternal abandonment (all P<0.05). Pairings showed that the incidences of threatened uterine rupture and maternal abandonment in 0-6 group was lower than those in 7-9 and 10-15 groups, and the differences were statistically significant (all P<0.05). (3) Maternal and neonatal complications mainly included postpartum hemorrhage and neonatal asphyxia, but there were no significant difference in the incidence of TOLAC success or failure among the three groups (all P>0.05). There was no uterine rupture in all groups. (4) The main factors affecting TOLAC score of pregnant women in the three groups included natural labor, estimated weight of the fetus at this time, Bishop score of the cervix at admission and gestational age, and the scores of the above indexes in 10-15 group were significantly higher than those in 0-6 group and 7-9 group (all P<0.05). Conclusions: TOLAC scoring scale has more accurate evaluation ability for VBAC, which could improve the success rate of TOLAC and maternal and child safety. The score of 0-6 is not recommended for vaginal trial labor, the score of 7-9 is recommended for vaginal trial labor, and the score of 10-15 is strongly recommended for vaginal trial labor.
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Affiliation(s)
- D M Zhang
- Department of Obstetrics and Gynecology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450052, China
| | - Y L Wang
- Department of Obstetrics and Gynecology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450052, China
| | - W W Liu
- Department of Obstetrics and Gynecology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450052, China
| | - L Y Xu
- Department of Obstetrics and Gynecology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450052, China
| | - S M Chen
- Department of Obstetrics and Gynecology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450052, China
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Dahal J, Saha R. Scar Rupture in Early Puerperium: A Case Report. JNMA J Nepal Med Assoc 2022; 60:491-493. [PMID: 35633242 PMCID: PMC9252228 DOI: 10.31729/jnma.7346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022] Open
Abstract
Uterine scar dehiscence or rupture is a rare but potentially life-threatening complication of caesarean delivery. It is the opening of the uterine incision line that can lead to postpartum haemorrhage, pelvic hematoma, pelvic abscess, endomyometritis, generalised or localised peritonitis and sepsis. Here we report a case of a 25 years old female who presented with puerperal pyrexia. Investigations revealed uterine scar rupture with a uterovesical collection. The case was managed conservatively with intravenous antibiotics, an intracervical Foley's catheter and a gonadotropin-releasing hormone agonist.
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Affiliation(s)
- Jyoti Dahal
- Department of Obstetrics and Gynecology, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
- Correspondence: Dr Jyoti Dahal, Department of Obstetrics and Gynecology, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal. , Phone: +977-9841303013
| | - Rachana Saha
- Department of Obstetrics and Gynecology, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
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50
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Sanín Blair JE, Sepulveda W, Etchegaray A, Ventura W, Corral E, Gutierrez-Marin J, Espinoza J. Uterine rupture in subsequent pregnancies following in utero spina bifida closure without stapled hysterotomy. Am J Obstet Gynecol 2022; 226:741-743. [PMID: 35065019 DOI: 10.1016/j.ajog.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/17/2022]
Affiliation(s)
- José E Sanín Blair
- Maternal-Fetal Medicine and Fetal Surgery, Department of Obstetrics and Gynecology, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Waldo Sepulveda
- FETALMED-Centro de Diagnostico Materno-Fetal, Santiago, Chile
| | - Adolfo Etchegaray
- Fetal Medicine Unit, Department of Obstetrics, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Walter Ventura
- Fetal Medicine Unit, Department of Obstetrics and Perinatology, Instituto Nacional Materno Perinatal, Lima, Peru
| | - Edgardo Corral
- Department of Obstetrics and Gynecology, Regional Hospital, Rancagua, Chile
| | - Jorge Gutierrez-Marin
- Maternal-Fetal Medicine and Fetal Surgery, Department of Obstetrics and Gynecology, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Jimmy Espinoza
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Fetal Center, 6651 Main St., Ste. 420, Houston, TX 77030.
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