Norwegian National Advisory Unit on Women's Health, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
Women and Children's Division, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
Acta Obstet Gynecol Scand. 2019 Aug;98(8):1024-1031. doi: 10.1111/aogs.13579. Epub 2019 Mar 10.
Complete uterine rupture, a rare peripartum complication, is often associated with a catastrophic outcome for both mother and child. However, few studies have investigated large datasets to evaluate maternal outcomes after complete ruptures, particularly in unscarred uteri. This paucity of studies is partly due to the rarity of both the event and the serious outcomes, such as peripartum hysterectomy and maternal death. The incidence of uterine rupture is expected to increase, due to increasing cesarean section rates worldwide. Thus, it is important to have more complete knowledge about the immediate maternal outcome following a complete uterine rupture. The objective was to identify maternal outcomes and their risk factors following complete uterine ruptures.
This was a population-based study using data from the Medical Birth Registry of Norway, the Patient Administration System and medical records. Maternities with complete uterine rupture after start of labor in Norway during 1967-2008 (n = 247 births), identified among 2 209 506 women. Uterine ruptures were identified from both registries and were further studied through a review of medical records. Only complete ruptures were included in analysis. The associations between maternal outcomes and demographic and labor risk factors were estimated. Odds ratios (ORs) were determined with crude logistic regressions for each risk factor. Separate multivariable logistic regressions were performed to calculate adjusted odds ratios and 95% confidence intervals (CIs).
We identified 88 (35.6%) healthy mothers, 107 (43.3%) severe postpartum hemorrhages without hysterectomy, 51 (20.6%) peripartum hysterectomies, and three (1.2%) maternal deaths. Peripartum hysterectomy decreased significantly in the last years of study. Unscarred uterine ruptures significantly increased the risk of peripartum hysterectomy compared with scarred uterine ruptures (AOR 2.6, 95% CI 1.3-5.3). Other factors that increased the risk of peripartum hysterectomy following rupture were: maternal age ≥35 years (AOR 2.3, 95% CI 1.1-5.0), parity ≥3 vs parity 1-2 (AOR 2.8, 95% CI 1.2-6.7), and rupture detection after vaginal delivery (AOR 2.2, 95% CI 1.1-4.8).
Unscarred uteri, older maternal age, parity ≥3, and rupture detection after vaginal delivery showed the highest associations with the risk of peripartum hysterectomy after complete uterine rupture.
完全性子宫破裂是一种罕见的围产期并发症，常导致母婴灾难性结局。然而，很少有研究对大量数据进行调查，以评估完全破裂后的产妇结局，尤其是在非瘢痕子宫中。由于全世界剖宫产率的增加，子宫破裂的发生率预计会增加，因此，对于完全性子宫破裂后即刻的产妇结局，我们需要有更全面的了解。目的是确定完全性子宫破裂后产妇结局及其危险因素。
本研究采用挪威医学出生登记处、患者管理系统和病历中的数据进行基于人群的研究。在 1967 年至 2008 年期间，挪威有 2 409 506 名产妇，其中 247 名产妇在分娩开始后发生完全性子宫破裂（n=247 例分娩）。从两个登记处识别出子宫破裂，并通过病历回顾进行进一步研究。仅纳入完全破裂进行分析。使用 logistic 回归估计产妇结局与人口统计学和分娩危险因素之间的相关性。对每个危险因素进行简单逻辑回归，计算比值比（OR）。对每个危险因素进行多变量逻辑回归，计算调整后的比值比和 95%置信区间（CI）。
我们确定了 88 名（35.6%）健康母亲、107 名（43.3%）无子宫切除的严重产后出血、51 名（20.6%）围生期子宫切除术和 3 名（1.2%）产妇死亡。近年来，围生期子宫切除术的比例显著下降。与瘢痕子宫破裂相比，非瘢痕子宫破裂显著增加了围生期子宫切除术的风险（调整比值比 2.6，95%CI 1.3-5.3）。破裂后增加围生期子宫切除术风险的其他因素包括：产妇年龄≥35 岁（调整比值比 2.3，95%CI 1.1-5.0）、产次≥3 次与产次 1-2 次（调整比值比 2.8，95%CI 1.2-6.7）和阴道分娩后破裂检测（调整比值比 2.2，95%CI 1.1-4.8）。
非瘢痕子宫、产妇年龄较大、产次≥3 次和阴道分娩后破裂检测与完全性子宫破裂后发生围生期子宫切除术的风险最高相关。
