Obstetric factors associated with uterine rupture in mothers who deliver infants with cerebral palsy

Abstract

Objective: The aim of the present study was to clarify the obstetric factors associated with uterine rupture in mothers who deliver infants with cerebral palsy (CP) in Japan.

Methods: This retrospective case-cohort study reviewed the obstetric characteristics and clinical courses of mothers who experienced uterine rupture and compared those who delivered an infant with CP (cases) with those who delivered an infant without CP (cohort). Data were obtained from the Japan Obstetric Compensation System for CP database (27 cases) and the perinatal database of the Japan Society of Obstetrics and Gynecology (312 cohorts). The subjects included live singleton infants delivered between 2009 and 2014 with a birth weight ≥2000 g and gestation ≥33 weeks.

Results: Augmentation was performed 33% in cases and 8% in cohorts (p < .001). The amount of bleeding during surgery was 1819 g in cases and 1096 g in cohorts (p < .001). Length of gestational weeks and neonatal birth weight were significantly higher and Apgar scores and umbilical arterial pH were lower in cases compared to cohorts (p < .001). In cases with CP, 11 cases of uterine rupture involved scarred uteruses. Seven were trial of labor after a previous cesarean. On one hand, 16 cases occurred in unscarred uteruses. Five of the uterine fundal pressure maneuvers and four of tachysystole due to excessive augmentation were reported in association with uterine rupture.

Conclusion: Two-third of the relevant obstetric factors for CP associated with uterine rupture were iatrogenic. At least, to reduce CP resulting from delivery-related uterine rupture, reckless delivery management should be avoided.

Keywords:

• Augmentation
• cerebral palsy
• previous cesarean section
• uterine fundal pressure maneuver
• uterine rupture

Acknowledgments

We wish to thank Prevention Recurrence Team member, Japan Council for Quality Health Care for their excellent support in data collection, organization, and statistical analysis. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Author contributions

JH, TI, EJ, and TI conceived the study, and JH and EJ wrote the initial protocol, analyzed the data, and wrote the first draft of the manuscript. All authors collected data and analyzed cases with CP. JH, TI, ST, EJ, and SS coordinated the study and JH and EJ produced the database. Statistical analyses were performed by ST and NT. All authors contributed to writing the paper. SS, KI, NT, AN, KF, TM, ST, HS, SU, MI and TI are the guarantors for the study. All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability

JOCSC

The data in the JOCSC were obtained with cooperation from the birthing facilities and families. It is, therefore, necessary for this organization to handle personal information with great care and thus, our policy is not to provide outside access to these data.

An article in the Standard Conditions of the Japan Obstetric Compensation System stipulates that access to the personal information of children who develop cerebral palsy and their families, as well as of the birthing facilities, is strictly limited to the staff of JCQHC.

JSOG

Data in the JSOG were obtained from secondary and tertiary care centers of the Perinatal Research Network, which belongs to the JSOG, as written in the issue. Hence, these data can be provided to only JSOG members who request to utilize the data set for obstetrical research, under the permission of both the JSOG Perinatal Committee and Information Committee. Subsequently, the study group, which includes JSOG members as co-authors, can utilize the database if the research objective and responsibility of data management are approved by JSOG committees. Requests regarding the JSOG database can be directed to the JSOG office (Japan Society of Obstetrics and Gynecology; Tokyo Tatemono Kyobashi Building, 3-6-18, Kyobashi, Chuo-ku, Tokyo 104-0031, JAPAN, TEL: [phone], FAX: [phone], E-mail: [email protected]) through a JSOG member (Mitsutoshi Iwashita; chair person in the present study group; e-mail: [email protected]).