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Spontaneous Uterine Rupture in Pregnancy


Chapter · January 2014
DOI: 10.1007/978-3-319-05422-3_16

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16.3 Risk Factors 497

Fig. 16.1 Comparison 3.0 29000


between the total number of
deliveries in 1970–1973 and 2.8 28000

Ruptured uterus rate per 1000 deli.


1980–1983 in relation to the 2.6 27000

Number of deliveries per year


rate of ruptured uterus per
1,000 deliveries in those 2.4 26000
years. (The numbers for 1983
are a multiplication of the first 2.0 25000
6 months) (R.U. rupture of the 2.0 24000
uterus) [42]
1.8 23000

1.6 22000

1.4 21000

1.2 20000

1.0 19000
1970 1971 1972 1973
1980 1981 1982 1983
Year

16.3.1.1 Previous Classic Cesarean 16.3.1.2 Previous Low-Vertical


Delivery Cesarean Delivery
Classic Cesarean delivery via vertical midline A meta-analysis demonstrated a 1.1 % absolute
uterine incision is currently infrequently per- risk of symptomatic uterine rupture in women
formed and account for 0.5 % of all births in the undergoing a TOLAC with a low-vertical
United States [56]. There is 11.5 % absolute risk Cesarean scar [58, 60–63]. Compared to women
of uterine rupture in women with classic vertical with low-transverse Cesarean scars, these data
Cesarean scars who underwent an unplanned suggest no significantly increased risk of uterine
TOLAC [57]. For women who underwent repeat rupture or adverse maternal and perinatal out-
Cesarean section, the uterine rupture rate for comes. Interpretation of these studies is hampered
women with prior classical uterine Cesarean scars by inconsistencies in how high the lower uterine
was 0.64 %. All patients in that study underwent segment could be cut before it was considered
repeat Cesarean delivery, but a high rate of preterm a classic incision. Even when the lower uterine
labor resulted in 49 % of the patients being in labor segment is already well developed as a result of
at the time of their Cesarean delivery [56]. Landon active labor, a low-vertical incision of adequate
et al. reported a 1.9 % absolute uterine rupture rate length is often impossible to permit fetal delivery.
in women with a previous classic, inverted T, or J Naef et al. arbitrarily defined a 2 cm extension
incision that either presented in advanced labor or into the upper segment as a classic extension, and
refused repeat Cesarean delivery [58]. These rates the overall rate of uterine rupture was 0.62 %.
of frank uterine rupture in women with classic This rate could be further divided as 1.15 % for
Cesarean deliveries are in contrast to the higher women who underwent a TOLAC compared with
rates of 4–9 % that the ACOG had historically no ruptures among women who underwent elec-
reported for women with these types of uterine tive repeat Cesarean delivery [60].
scars [59]. However, there is a 9 % rate of asymp-
tomatic uterine scar dehiscence observed [56]. 16.3.1.3 Unknown Uterine Scar
This result suggests that disruptions of uterine In many instances, the type of incision used for
scars might have been misclassified as true rup- a prior Cesarean delivery cannot be confirmed
tures instead of dehiscences in previous studies; due to unavailability of the operative report.
this error may explain the bulk of the discrepancy. Under these circumstances, the assessment of
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