Predicting the risks and recognizing the signs: a two-year prospective population-based study on pregnant women with uterine rupture in The Netherlands

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.

Keywords:

• Uterine rupture
• adverse outcome
• maternal morbidity
• perinatal morbidity
• CTG tracings

Acknowledgments

We would like to thank all health care givers in Dutch hospitals for cooperating with the registration process and filling in the case report forms.

Authors’ contributions

EO, KB and TS participated in the outline, design and coordination of the study. EO contacted hospitals, registered, and analyzed cases. NH and EO extracted data from hospital files, analyzed and interpreted data and wrote the article draft. AR extracted data for the reference group. EO, NH, KB, TvdA, TS, AR, TV and JZ contributed to interpretation of data edited and approved the final version of the article.

Details of ethical approval

All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The NethOSS registration system is part of the National Perinatal Registry foundation in the Netherlands (Perined). This study did not require specific ethical approval and Informed consent of participants was not obtained since Perined is allowed administrative permission in the Netherlands to access patient information from patient charts if the information used is not personally identifiable, concerns large numbers of participants and it is not feasible to trace and contact individual participants.

Disclosure statement

The authors report no conflict of interest.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

No funding was received.