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Risk factors for maternal complications following uterine rupture: a 12-year single-center experience

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To determine maternal outcomes and risk factors for composite maternal morbidity following uterine rupture during pregnancy.

Methods

A retrospective cohort study including all women diagnosed with uterine rupture during pregnancy, between 2011 and 2023, at a single-center. Patients with partial uterine rupture or dehiscence were excluded. We compared women who had composite maternal morbidity following uterine rupture to those without. Composite maternal morbidity was defined as any of the following: maternal death; hysterectomy; severe postpartum hemorrhage; disseminated intravascular coagulation; injury to adjacent organs; admission to the intensive care unit; or the need for relaparotomy. The primary outcome was risk factors associated with composite maternal morbidity following uterine rupture. The secondary outcome was the incidence of maternal and neonatal complications following uterine rupture.

Results

During the study period, 147,037 women delivered. Of them, 120 were diagnosed with uterine rupture. Among these, 44 (36.7%) had composite maternal morbidity. There were no cases of maternal death and two cases of neonatal death (1.7%); packed cell transfusion was the major contributor to maternal morbidity [occurring in 36 patients (30%)]. Patients with composite maternal morbidity, compared to those without, were characterized by: increased maternal age (34.7 vs. 32.8 years, p = 0.03); lower gestational age at delivery (35 + 5 vs. 38 + 1 weeks, p = 0.01); a higher rate of unscarred uteri (22.7% vs. 2.6%, p < 0.01); and rupture occurring outside the lower uterine segment (52.3% vs. 10.5%, p < 0.01).

Conclusion

Uterine rupture entails increased risk for several adverse maternal outcomes, though possibly more favorable than previously described. Numerous risk factors for composite maternal morbidity following rupture exist and should be carefully assessed in these patients.

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Data availability

The dataset used and analyzed for the study is available from the corresponding author upon a reasonable request.

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Acknowledgements

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Funding

The authors declare that no funds, grants, or other support was received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel

    Uri Amikam, Shani Abramov, Anat Lavie, Yariv Yogev & Liran Hiersch

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Uri Amikam, Alyssa Hochberg, Shani Abramov, Anat Lavie, Yariv Yogev & Liran Hiersch

  3. Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tiqva, Israel

    Alyssa Hochberg

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  1. Uri Amikam
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Contributions

UA project development, data collection, data analysis, manuscript writing. AH project development, manuscript editing. SA data collection, data analysis. AL project development, manuscript editing. YY project development, manuscript editing. LH project development, data analysis, manuscript writing. All authors read and approved the final manuscript.

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Correspondence to Uri Amikam.

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The authors have no relevant financial or non-financial interests to disclose.

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This study was approved by institutional review board (IRB TLV-0284-08).

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Informed consent was waived due to the retrospective design of the study.

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Amikam, U., Hochberg, A., Abramov, S. et al. Risk factors for maternal complications following uterine rupture: a 12-year single-center experience. Arch Gynecol Obstet 309, 1863–1871 (2024). https://doi.org/10.1007/s00404-023-07061-1

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  • DOI: https://doi.org/10.1007/s00404-023-07061-1

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