Introduction. Uterine rupture is a tearing of uterine wall during pregnancy or delivery. There are two types of uterine rupture described in literature: symptomatic (SUR) and asymptomatic (AUR) uterine rupture. In case of SUR there is a full thickness uterine wall tear which leads to clinical symptoms and high perinatal and maternal morbidity and mortality. In case of AUR the visceral peritoneum remains intact and it is typically diagnosed during Cesarean section. Rupture of previously intact uterus is very rare and is associated with extensive uterine damage, severe hemorrhage and in most cases leads to hysterectomy. Fetal complications include admission to neonatal intensive care unit, hypoxic - ischemic injury and death. Maternal complications include hemorrhage, hypovolemic shock, bladder injury, hysterectomy and maternal death. The incidence and prevalence of uterine rupture as well as the perinatal and maternal rate of complications in Latvia is unknown.
Aim of the Study. Aim of the study is to analyze clinical cases of SUR and AUR, calculate the incidence and prevalence and detect the risk factors (RFs) and diagnostic difficulties of clinical cases which occurred in Riga Maternity Hospital from year 2010 to 2017.
Material and methods. A case series study of 41 uterine ruptures which occurred in Riga Maternity Hospital from the 1st of January 2010 until the 31st of December 2016 was performed. An average birth rate for this time period was 6554 live births per year.
Results. Over the time period 41 women with uterine rupture were diagnosed in Riga Maternity Hospital. AUR was diagnosed in 33 patients during Cesarean section. SUR occurred in seven patients, but in total there were eight cases of SUR, because one of the patients had a uterine rupture twice. SUR incidence in Riga Maternity Hospital is 1.7 per 10000 deliveries (8 per 45875 deliveries) and the prevalence is 0.0175%. In three cases SUR was diagnosed after labor and in five cases - during emergency laparotomy. SUR most frequently manifested with hypovolemic shock and/or acute abdomen. In two cases uterine defect was repaired and in six cases hysterectomy was performed. One patient had acute kidney injury and there was one case of maternal death. Nine babies were delivered and the Apgar score after the 1st minute was ≥ 7 in three cases and < 7 in three cases, but after the 5th minute it was ≥ 7 in five cases and <7 in one case. There were three intrauterine fetal demises. All the patients with either SUR or AUR had multiple RFs for uterine rupture.
Conclusions. Uterine rupture is associated with multiple RFs. If trial of labor after Cesarean section is the preferred mode of delivery it is necessary to detect all of the RFs. Antenatal measurement of lower uterine segment thickness seems unreliable but further research should be carried out with statistical data analysis. For the safety of patients trial of vaginal delivery in patient with uterine scar should be performed in appropriately equipped and staffed medical facilities.
1. Astatikie G, Limenih MA, Kebede M. Maternal and fetal outcomes of uterinerupture and factors associated with maternal death secondary to uterine rupture // BMC Pregnancy Childbirth, 2017 Apr 12;17(1):117.
2. Bij de Vaate A.J.M., van der Voet L.F., Naji O, Wimer M, Veersema S., Brölam H.A.M., Bourne T., Huirne J.A.F. Reply: Niche risk factor for uterine rupture? // Ultrasound Obstet Gynecol 2014; 44:371-372
3. Colmorn LB, Langhoff-Roos J, Jakobsson M, Tapper AM, Gissler M, Lindqvist PG, Källen K, Gottvall K, Klungsøyr K, Bøhrdahl P, Bjarnadóttir RI, Krebs L. NationalRates of Uterine Rupture are not Associated with Rates of Previous CaesareanDelivery: Results from the Nordic Obstetric Surveillance Study // Paediatr Perinat Epidemiol. 2017 May;31(3):176-182
4. Eguzo KN, Umezurike CC. Rupture of unscarred uterus: a multi-year cross-sectional study from Nigerian Christian Hospital, Nigeria // Int J Reprod Contracept Obstet Gynecol. 2013;2(4):657–660
5. Eshkoli T, Weintraub AY, Baron J, Sheiner E. The significance of a uterinerupture in subsequent births // Arch Gynecol Obstet. 2015 Oct;292(4):799-803
6. Hofmeyr GJ, Say L, Gülmezoglu AM. WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture // BJOG. 2005 Sep;112(9):1221-8
7. Iemura A, Kondoh E, Kawasaki K, Fujita K, Ueda A, Mogami H, Baba T, Konishi I. Expectant management of a herniated amniotic sac presenting as silent uterinerupture: a case report and literature review // J Matern Fetal Neonatal Med. 2015 Jan;28(1):106-12
8. Jastrow N, Chaillet N, Roberge S, Morency AM, Lacasse Y, Bujold E. Sonographiclower uterine segment thickness and risk of uterine scar defect: a systematicreview // J Obstet Gynaecol Can. 2010 Apr;32(4):321-7
9. Koo YJ, Lee JK, Lee YK, Kwak DW, Lee IH, Lim KT, Lee KH, Kim TJ. PregnancyOutcomes and Risk Factors for Uterine Rupture After Laparoscopic Myomectomy: ASingle-Center Experience and Literature Review // J Minim Invasive Gynecol. 2015 Sep-Oct;22(6):1022-8
10. Mukasa PK, Kabakyenga J, Senkungu JK, Ngonzi J, Kyalimpa M, Roosmalen VJ. Uterine rupture in a teaching hospital in Mbarara, western Uganda, unmatched case-control study // Reprod Health. 2013;10(1):1
11. Ofir K, Sheiner E, Levy A, Katz M, Mazor M. Uterine rupture: differences between a scarred and an unscarred uterus // American Journal of Obstetrics and Gynecology 2004;191:425–429
12. Ofir K, Sheiner E, Levy A, Katz M, Mazor M. Uterine rupture: risk factors and pregnancy outcome // American Journal of Obstetrics and Gynecology 2003; 189:1042–1046
13. Omole-Ohonsi A, Attah R. Risk factors for ruptured uterus in a developing country. Gynecol Obstetric. 2011;1(102):2161–0932.4. Berhe Y, Wall LL. Uterine rupture in resource-poor countries // Obstet Gynecol Surv. 2014 Nov;69(11):695-707
14. Osemwenkha PA, Osaikhuwuomwan JA. A 10- year review of uterine rupture and its outcome in the University of Benin Teaching Hospital, Benin City // Niger J Surg Sci 2016; 26:1-4