Outcomes of uterine rupture in unscarred compared with the scarred uterus: analysis of 61 complete uterine rupture.

BACKGROUND

Uterine rupture, though rare, is a severe complication during pregnancy. While a scarred uterus is a well-recognized high-risk factor for uterine rupture during pregnancy, the significant risk of complete uterine rupture in non-scarred uteri cannot be overlooked in clinical practice.

METHODS

This retrospective multicenter study collected data on all cases of complete uterine rupture that occurred from January 2012 to December 2016 across 11 hospitals in Beijing and 2 hospitals in the Ningxia Hui Autonomous Region. The study examined the clinical characteristics and outcomes for both mothers and fetuses.

RESULTS

From January 2012 to December 2016, a total of 227,983 deliveries were recorded across the 13 hospitals included in the study, with 61 cases of complete uterine rupture, yielding an incidence of 2.67 per 10,000 deliveries. Among these 61 cases, 35 (57.4%) had a cesarean section scar, 11 (18.0%) had a history of uterine fibroid enucleation, and 15 (24.6%) had no apparent uterine body scar. For patients with scarred uteri who experienced rupture, the hysterectomy rate was 17.4% (8/46), and the rate of severe postpartum hemorrhage was 23.9% (11/46). In contrast, for patients with non-scarred uteri, the hysterectomy rate was 13.3% (2/15), and the rate of severe postpartum hemorrhage was 40% (6/15). The perinatal mortality rate was 23.9% (11/46) for patients with scarred uterus rupture, compared to 40% (6/15) for those with non-scarred uterus rupture. Complete uterine rupture in non-scarred uteri was associated with an increased risk of adverse fetal/neonatal outcomes (severe asphyxia or fetal/neonatal death) (OR = 3.784, 95%CI: 0.82-17.5, p = 0.88).

CONCLUSION

In obstetric clinical practice, it is crucial to focus not only on patients with uterine body scars and the risk of uterine rupture during pregnancy and childbirth, but also on the possibility of uterine rupture in other patients who may have potential uterine scars. These cases may be easily overlooked, leading to delayed diagnosis and, consequently, adverse outcomes for both mother and fetus.