Predicting the risks and recognizing the signs: a two-year prospective population-based study on pregnant women with uterine rupture in The Netherlands
The Journal of Maternal-Fetal & Neonatal Medicine, vol. 37, pp. 2311083
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.
Authors 7
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Evelien M. Overtoom corresponding
University Medical Center Utrecht · Diakonessenhuis hospital · Wilhelmina Children's Hospital
Affiliation as printed
Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, The Netherlands
Department of Obstetrics, Birth Centre Wilhelmina Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
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Affiliation as printed
Perined, Utrecht, The Netherlands
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Affiliation as printed
Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, The Netherlands
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University Medical Center Utrecht · Wilhelmina Children's Hospital
Affiliation as printed
Department of Obstetrics, Birth Centre Wilhelmina Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
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Affiliation as printed
Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, The Netherlands
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Leiden University · Leiden University Medical Center · Vrije Universiteit Amsterdam
Affiliation as printed
Athena Institute, VU University, Amsterdam, The Netherlands
Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
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University Medical Center Utrecht · Wilhelmina Children's Hospital
Affiliation as printed
Department of Obstetrics, Birth Centre Wilhelmina Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
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