Predictors of Uterine Rupture After One Previous Cesarean Section: An Unmatched Case–Control Study

Figures & data

Table 1 Sociodemographic and Pregnancy Related Factors

Variables	Responses	Case (35)	Control (70)	P value
		Frequency (%)	Frequency (%)
Age(years)	<35	29 (82.9)	61 (87.1)	12.958 (0.554)
	≥ 35	6 (17.1)	9 (12.9)
	Mean (SD)	28.54 (±4.24)	28.01 (±4.81)
Residency	Urban	17 (48.6)	56 (80)	10.22 (0.001)
	Rural	18 (51.4)	14 (20)
Educational status	No formal education	12 (34.3)	1 (1.4)	23.3 (0.001)
	Formal education	23 (65.7)	69 (98.6)
Address	Hawassa city	3 (8.6)	22 (31.4)	0.823 (0.491)
	SNNPR	14 (40)	9 (12.9)
	Oromia Region	18 (51.4)	39 (55.7)
Number of ANC visit	Less than 4	23 (65.7)	27 (38.6)	33.373 (0.00)
	Four and above	12 (34.3)	43 (61.4)
Gravidity	Parity 1–4	29 (82.9)	69 (98.6)	9.2 (0.002)
	Parity ≥5	6 (17.1)	1 (1.4)
Gestational age	<37 week	1 (33)	2 (2.8)	3.13 (0.73)
	≥ 37 week	34 (33)	68 (97.2)
Duration since the last uterine scar	< 18 months	0	4 (5.7)	7.47 (0.025)
	19–59 months	22 (62.8)	55 (78.6)
	>60 months	13 (37.2)	11 (15.7)
Congenital anomalies	No	35 (100)	70 (100)
Other medical/obstetric conditions	Yes	1 (2.9)	9 (12.9)	2.7 (0.159)
	NO	34 (97.1)	61 (87.1)

Table 2 Intrapartum Characteristics of the Mothers

Variable	Response	Case (35)	Control (70)	X^2 (P value)
		Frequency (%)	Frequency (%)
Onset of labor	Spontaneous	35 (100)	70 (100)
Use of partograph	Yes	3 (8.6)	20 (28.6)	362 (0.45)
	No	32 (91.4)	48 (71.4)
Obstructed labor	Yes	4 (11.4)	NA	1.2 (0.372)
	No	31 (88.6)	70 (100)
Trial of instrumental delivery	Yes	1 (2.9)	0	2.1 (0.389)
	No	34 (97.1)	70 (100)
TOLAC	No	32 (91.4)	60 (85.7)	9.33 (0.77)
	Yes	3 (8.6)	10 (14.3)
Previous vaginal delivery	Yes	11 (31.4)	49 (70)	14.8 (0.01)
	No	24 (68.6)	21 (30)
Diagnosis of rupture	Latent phase of labor	15 (42.9)	N/A
	Active phase of labor	7 (20)	N/A
	Second stage of labor	12 (34.3)	N/A
	Postpartum	1 (2.9)	N/A
SVD	Yes	No	Yes
Laparotomy delivery	Yes	Yes	No
Fetal weight	≤3800	14 (41.2)	49 (70)	7.6 (0.003)
	≥3801	20 (58.8)	21 (30)
Type of referring institution	None (from Home)	0	23 (32.9)	35.9 (0.001)
	Health center	7 (20)	27 (38.6)
	Primary Hospital	10 (28.6)	15 (21.4)
	General Hospital	11 (31.4)	2 (2.9)
	Referral Hospital	7 (20)	3 (4.3)
Number of health facilities before arrival at HUCSH	None (from Home)	0	25 (35.7)	54.4 (0.002)
	One	5 (14.3)	37 (52.9)
	Two	27 (77.1)	8 (11.4)
	Three and above	3 (8.6)	0
The duration between admission and surgery (in hours)	Median	1	N/A
	Range	1–3 hour	N/A
Duration of hospital stay(days)	Median (days)	3	2.19 (±2.3)
	Range (days)	1–15	1–5

Table 3 The Maternal Perioperative Clinical Condition

Variable	Response	Case (35)	Control (70)	X^2 (p value)
		Frequency (%)	Frequency (%)
Maternal condition on admission	Stable (normal BP)	25 (71.4)	70 (100)	22.9 (0.001)
	Shock	10 (28.6)	0
Weight of the baby (in grams)	Mean (-+SD)	3523.5 (+-551)	3252.9 (666.8)	108.59 (0.001)
Status of the baby at birth	Alive with a good APGAR score	0	70 (100)	500.223 (0.001)
	Alive with a low APGAR score	3(8.6)	0
	Dead	32 (91.4)	0
Condition of the mother on discharge	Alive	34 (97.1)	70 (100)	22.424 (0.001)
	Dead	1 (2.9)	0
Type of uterine rupture	LUST (lower uterine segment transverse cesarean section)	31 (88.5)	NA
	LUS vertical	3 (8.6)	NA
	Died before surgery	1 (2.9)	NA
Intra-operative complication	Bladder rupture	3 (8.6)	NA
	Uterine artery involvement	4 (11.4)	NA
Management	Repair	5 (14.3)	NA
	TAH (total abdominal hysterectomy)	23 (65.6)	NA
	STH (subtotal hysterectomy)	3 (8.6)	NA
	TAH and bladder repair	3 (8.6)	NA
	Died before surgery	1 (2.9)	NA
Post OP complication	Anemia that requires transfusion	22 (62.8)	NA

Table 4 Factors Associated with Cesarean Scar Dehiscence

Variables	Response	COR (95% CI)	AOR (95% CI)	P-value
Residency	Urban	1	1	0.7
	Rural	11.47(7.6–17.3)	1.95(0.9 5–4)
Age (years)	<35	1	1	0.36
	≥35	2.26(1.44–3.54)	0.63(0.23–1.87)
Number of ANC	<4	3.5(1.32–7.26)	3.6(1.05–12.54)	0.03
	≥4	1	1
Previous vaginal delivery	Yes	1	1	0.02
	No	2.1(1.92–3.43)	3.4(2.45–5.01)
Gravidity	1–4	1	1	0.22
	≥5	17.26(1.72–12.44)	4.7(1.48–23.3)
TOLAC	Yes	1	1	0.33
	No	4.76(1.62–12.87)	3.52(0.18–20.3)
Maternal education	No formal education	36.35(4.69–200.19)	9.9(1.19 −108.5)	0.071
	Formal education	1	1
Fetal weight	<3800	1	1	0.0001
	≥3801	6.6(2.26–20.32)	5.21(1.14–23.8)
Duration since the last uterine scar	19–59 months	1	1	0.09
	Short and long intervals	2.95(1.13–7.08)	3.97(1.05–14.96)
Duration of labor	<15 hrs.	1	1	0.001
	≥ 15 hrs.	10.43(2.12–51.4)	10.7(1.3–88.4)

Note: Bold font indicates strong association.