Trends, risk factors and pregnancy outcome in women with uterine rupture.

OBJECTIVE

This study aimed at determining trends, risk factors and pregnancy outcome in women with uterine rupture.

METHODS

A population-based study, comparing all singleton deliveries with and without uterine rupture between 1988 and 2009 was conducted. Statistical analysis was performed using a multiple logistic regression analysis.

RESULTS

Uterine rupture occurred in 0.06% (n = 138) of all deliveries included in the study (n = 240,189); 59% in women with a previous cesarean delivery (CD). A gradual increase in the rate of uterine rupture from 1988 (0.01%) to 2009 (0.05%) was noted. Independent risk factors for uterine rupture in a multivariable analysis were: previous CD (OR = 7.4, 95% CI 5.2-10.6), preterm delivery (<37 weeks, OR = 2.5, 95% CI 1.5-4.1), malpresentation (OR = 3.0, 95% CI 1.9-4.5), parity (OR = 1.2, 95% CI 1.1-1.3 for each birth), and dystocia during the first and second stages of labor (OR = 4.1, 95% CI 2.3-7.4 and OR = 11.2, 95% CI 6.7-18.7, respectively). Uterine rupture led to significant maternal morbidity and perinatal mortality. In another multivariable analysis, with perinatal mortality as the outcome variable uterine rupture was noted as an independent risk factor for perinatal mortality (adjusted OR = 17.7; 95% CI 10.0-31.4, P < .01).

CONCLUSIONS

Uterine rupture, associated with previous cesarean delivery, malpresentation, and labor dystocia, is an independent risk factor for perinatal mortality.