Fetomaternal outcome of scarred uterine rupture compared with primary uterine rupture: a retrospective cohort study

Makkam S. Madhuri; Nivedita Jha; Veena Pampapati; Latha Chaturvedula; Ajay Kumar Jha

doi:10.1515/jpm-2023-0018

Article

Fetomaternal outcome of scarred uterine rupture compared with primary uterine rupture: a retrospective cohort study

Makkam S. Madhuri , Nivedita Jha , Veena Pampapati , Latha Chaturvedula and Ajay Kumar Jha

Published/Copyright: May 2, 2023

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From the journal Journal of Perinatal Medicine Volume 51 Issue 8

Abstract

Objectives

Literature comparing maternal and perinatal outcomes among women with scarred and primary uterine rupture are limited. Therefore, the study aimed to compare maternal and perinatal outcomes and associated risk factors of uterine rupture among scarred and unscarred uterus.

Methods

This retrospective cohort study was performed at a large tertiary care of India between July 1, 2011 and June 30, 2020. We analysed all the cases of complete uterine rupture beyond the 20th week of gestation. The outcome measures were live birth rate, perinatal mortality, maternal mortality and morbidity.

Results

A total of 115 complete uterine ruptures were noted in 148,102 pregnancies. Of those 115 uterine ruptures, 89 (77.3 %) uterine ruptures occurred in women with a history of caesarean delivery, and 26 (22.6 %) uterine ruptures occurred in primary uterine rupture. The primary uterine rupture group had a significantly higher incidence of lower parity, breech presentation and mean birth weight. The live birth rate (68.18% vs. 42.85 %; p=0.04) was significantly higher in the scarred group, and the stillbirth rate (57.14% vs. 31.86 %; p=0.009) was significantly higher in the primary uterine rupture group. Hypoxic ischemic encephalopathy, APGAR score, and neonatal intensive care unit admission were comparable. Postpartum haemorrhage, blood transfusion, severe acute maternal morbidity and intensive care unit stay were more frequently reported in the primary uterine rupture group.

Conclusions

The maternal and perinatal outcomes appear less favourable among women with primary uterine rupture than scarred uterine rupture.

Keywords: fetal death; maternal morbidity; maternal mortality; neonatal morbidity; outcomes; primary uterine rupture; scarred uterus; uterine rupture

Corresponding author: Nivedita Jha, MBBS, MS, Associate Professor, Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India, Phone: +919487581663, E-mail: dr.niveditajha@gmail.com

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Not applicable.
Ethical approval: The study was approved by Institute Ethics Committee JIPMER, Puducherry, India (JIP/IEC/2020/255 dated 02/11/2020).

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/jpm-2023-0018).

Received: 2023-01-12

Accepted: 2023-04-15

Published Online: 2023-05-02

Published in Print: 2023-10-26

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Supplementary Material

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https://doi.org/10.1515/jpm-2023-0018

Keywords for this article

fetal death; maternal morbidity; maternal mortality; neonatal morbidity; outcomes; primary uterine rupture; scarred uterus; uterine rupture