Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium.
Department of Obstetrics and Gynaecology, Birth Centre Wilhelmina's Children Hospital, Devision Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands.
BJOG. 2019 Feb;126(3):370-381. doi: 10.1111/1471-0528.15271. Epub 2018 Jun 12.
International comparison of complete uterine rupture.
Descriptive multi-country population-based study.
International.
International Network of Obstetric Survey Systems (INOSS).
We merged individual data, collected prospectively in nine population-based studies, of women with complete uterine rupture, defined as complete disruption of the uterine muscle and the uterine serosa, regardless of symptoms and rupture of fetal membranes.
Prevalence of complete uterine rupture, regional variation and correlation with rates of caesarean section (CS) and trial of labour after CS (TOLAC). Severe maternal and perinatal morbidity and mortality.
We identified 864 complete uterine ruptures in 2 625 017 deliveries. Overall prevalence was 3.3 (95% CI 3.1-3.5) per 10 000 deliveries, 22 (95% CI 21-24) in women with and 0.6 (95% CI 0.5-0.7) in women without previous CS. Prevalence in women with previous CS was negatively correlated with previous CS rate (ρ = -0.917) and positively correlated with TOLAC rate of the background population (ρ = 0.600). Uterine rupture resulted in peripartum hysterectomy in 87 of 864 women (10%, 95% CI 8-12%) and in a perinatal death in 116 of 874 infants (13.3%, 95% CI 11.2-15.7) whose mother had uterine rupture. Overall rate of neonatal asphyxia was 28% in neonates who survived.
Higher prevalence of complete uterine ruptures per TOLAC was observed in countries with low previous CS and high TOLAC rates. Rates of hysterectomy and perinatal death are about 10% following complete uterine rupture, but in women undergoing TOLAC the rates are extremely low (only 2.2 and 3.2 per 10 000 TOLACs, respectively.) TWEETABLE ABSTRACT: Prevalence of complete uterine rupture is higher in countries with low previous CS and high TOLAC rates.
比较完整的子宫破裂。
多国描述性基于人群的研究。
国际。
国际产科调查系统网络（INOSS）。
我们合并了九个基于人群的前瞻性研究中收集的个体数据，这些数据涉及完整子宫破裂的妇女，定义为子宫肌肉和子宫浆膜完全破裂，无论症状和胎膜破裂如何。
完整子宫破裂的发生率、地区差异以及与剖宫产率（CS）和剖宫产后试产（TOLAC）的相关性。严重的孕产妇和围产儿发病率和死亡率。
我们在 2625017 次分娩中发现了 864 例完全子宫破裂。总体发生率为每 10000 次分娩 3.3（95%CI 3.1-3.5），有剖宫产史的妇女发生率为 22（95%CI 21-24），无剖宫产史的妇女发生率为 0.6（95%CI 0.5-0.7）。有剖宫产史的妇女的破裂发生率与剖宫产率呈负相关（ρ=-0.917），与背景人群的 TOLAC 率呈正相关（ρ=0.600）。864 例子宫破裂妇女中有 87 例（10%，95%CI 8-12%）需要在围产期行子宫切除术，874 例婴儿中有 116 例（13.3%，95%CI 11.2-15.7）的母亲发生子宫破裂，导致围产儿死亡。存活新生儿的新生儿窒息发生率总体为 28%。
在剖宫产率低、TOLAC 率高的国家，完整的子宫破裂发生率更高。完全性子宫破裂后行子宫切除术和围产儿死亡的发生率约为 10%，但在 TOLAC 后，这两种情况的发生率极低（分别仅为每 10000 次 TOLAC 中 2.2 和 3.2 例）。
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