Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
Rev Bras Ginecol Obstet. 2021 Nov;43(11):820-825. doi: 10.1055/s-0041-1739461. Epub 2021 Dec 6.
To compare maternal and perinatal risk factors associated with complete uterine rupture and uterine dehiscence.
Cross-sectional study of patients with uterine rupture/dehiscence from January 1998 to December 2017 (30 years) admitted at the Labor and Delivery Unit of a tertiary teaching hospital in Canada.
There were 174 (0.1%) cases of uterine disruption (29 ruptures and 145 cases of dehiscence) out of 169,356 deliveries. There were associations between dehiscence and multiparity (odds ratio [OR]: 3.2; = 0.02), elevated maternal body mass index (BMI; OR: 3.4; = 0.02), attempt of vaginal birth after a cesarian section (OR: 2.9; = 0.05) and 5-minute low Apgar score (OR: 5.9; < 0.001). Uterine rupture was associated with preterm deliveries (36.5 ± 4.9 versus 38.2 ± 2.9; = 0.006), postpartum hemorrhage (OR: 13.9; < 0.001), hysterectomy (OR: 23.0; = 0.002), and stillbirth (OR: 8.2; < 0.001). There were no associations between uterine rupture and maternal age, gestational age, onset of labor, spontaneous or artificial rupture of membranes, use of oxytocin, type of uterine incision, and birthweight.
This large cohort demonstrated that there are different risk factors associated with either uterine rupture or dehiscence. Uterine rupture still represents a great threat to fetal-maternal health and, differently from the common belief, uterine dehiscence can also compromise perinatal outcomes.
比较与完全性子宫破裂和子宫破裂相关的母体和围生期危险因素。
对 1998 年 1 月至 2017 年 12 月（30 年）期间在加拿大一家三级教学医院分娩和分娩单位就诊的子宫破裂/破裂患者进行横断面研究。
在 169356 例分娩中，有 174 例（0.1%）发生子宫破裂（29 例破裂和 145 例破裂）。子宫破裂与多胎妊娠（比值比[OR]：3.2；=0.02）、产妇体重指数（BMI）升高（OR：3.4；=0.02）、剖宫产术后阴道试产（OR：2.9；=0.05）和 5 分钟低 Apgar 评分（OR：5.9；<0.001）有关。子宫破裂与早产（36.5±4.9与 38.2±2.9；=0.006）、产后出血（OR：13.9；<0.001）、子宫切除术（OR：23.0；=0.002）和死胎（OR：8.2；<0.001）有关。子宫破裂与产妇年龄、胎龄、临产开始、自发性或人工破膜、催产素使用、子宫切口类型和出生体重无关。
本大规模队列研究表明，与子宫破裂或破裂相关的危险因素不同。子宫破裂仍然对母婴健康构成巨大威胁，而且与普遍的看法不同，子宫破裂也会影响围产期结局。
