Uterine rupture during pregnancy and delivery: risk factors, symptoms and maternal and neonatal outcomes-restrospective cohort

Objective: To analyze cases of uterine rupture during pregnancy and delivery. To report risk factors. maternal and neonatal outcomes. Design: Restrospective cohort study. Setting: Department of Obstetrics and Gynecology, Masaryk University, University Hospital Brno. Methods: This study used data from medical records of 36195 labours between 2011-2016 in the Department of Obstetrics and Gynecology Masaryk University Hospital Brno. We identified all cases of complete and incomplete uterine rupture diagnosed during pregnancy, delivery and puerperium. We analyzed risk factors, symptoms and signs and maternal and neonatal outcomes. Results: We identified 15 uterine ruptures. Three cases occurred during pregnancy in absence of labour, ten cases in association with delivery, one case during puerperium and one case of uterine rupture was associated with induction of abortion in the 2nd trimester. Eight patients had a previous cesarean section. Other uterine surgery was reported in history of four cases. including myomectomy, perforation of uterine fundus during hysteroscopy. curretage. Three patients had unscarred uterus. Most of the cases presented with abnormal fetal heart rate tracing, abdominal pain, vaginal bleeding and hypotension. There were two perinatal deaths associated with uterine rupture and perinatal asphyxia was observed in five infants. No mother died in association with uterine rupture. Estimated blood loss higher than 1000 ml occurred in 11 cases. Three patients underwent hysterectomy. Conclusion: Overall prevalence of uterine rupture during pregnancy and delivery was 0,04%, in women with previous cesarean section was 0.2%, in women with unscarred uterus was 0.08 parts per thousand. Suspicious fetal heart rate tracing and acute abdominal pain are the most common symptoms. Adverse neonatal outcomes were identified in seven cases.