Symptomatic Uterine Rupture: A Fifteen Year Review

Abstract

Background and objectives: To assess the incidence of complete and partial uterine rupture during childbirth in a single tertiary referral centre as well as the significant risk factors, symptoms and peripartum complications. Materials and Methods: A retrospective single-centre study involved all cases of uterine rupture at the Kaunas Perinatal Centre in 2004–2019. Data were from a local medical database complemented with written information from medical records. We included 45,893 women with an intact uterus and 5630 with uterine scars. Women (n = 5626) with scarred uterus’ after previous cesarean delivery. The diagnosis was defined by clinical symptoms, leading to an emergency cesarean delivery, when complete or partial uterine rupture (n = 35) was confirmed. Asymptomatic cases, when uterine rupture was found at elective cesarean section (n = 3), were excluded. The control group is represented by all births delivered in our department during the study period (n = 51,525). The outcome was complete (tearing of all uterine wall layers, including serosa and membranes) and partial uterine rupture (uterine muscle defect but intact serosa), common uterine rupture symptoms. Risk factors were parameters related to pregnancy and labour. Results: 51,525 deliveries occurred in Kaunas Perinatal Centre during the 15 years of the study period. A total number of 35 (0.06%) symptomatic uterine ruptures were recorded: 22 complete and 13 partial, leading to an incidence rate of 6.8 per 10,000 deliveries. The uterine rupture incidence rate after a single previous cesarean delivery is 44.4 per 10,000 births. 29 (83%) cases had a uterine scar after previous cesarean, 4 (11%) had a previous laparoscopic myomectomy, 2 (6%) had an unscarred uterus. The most significant risk factors of uterine rupture include uterine scarring and augmentation or epidural anaesthesia in patients with a uterine scar after cesarean delivery. The most common clinical sign was acute abdominal pain in labour 18 (51%). No maternal, six intrapartum perinatal deaths (17%) occurred, and one hysterectomy (2.8%) was performed due to uterine rupture. Neonatal mortality reached 22% among the complete ruptures. Average blood loss was 1415 mL, 4 (11%) patients required blood transfusion. Conclusions: The incidence rate of uterine rupture (complete and incomplete) at Kaunas Perinatal Centre is 6.8 per 10,000 deliveries. In cases with a scar of the uterus after a single cesarean, the incidence of uterine rupture is higher, exceeding 44 cases per 10,000 births. The most significant risk factors were uterine scar and augmentation or epidural anaesthesia in a previous cesarean delivery. Acute abdominal pain in labour is the most frequent symptom for uterine rupture.