To describe maternal and neonatal outcomes of pregnancies complicated by uterine rupture at a single institution.
Retrospective review of pregnancies complicated by uterine rupture from 2009-2016. Uterine rupture was defined as a uterine defect involving the entire thickness of the uterine wall. Maternal and neonatal outcomes were analyzed. If cesarean delivery was performed, time was calculated from decision to perform surgery to skin incision. Standard statistical analysis was performed.
There were 40 cases of uterine rupture with an overall rate of 4.9 ruptures per 10,000 births. The rupture rate did not change over time (P=0.23). Of primary uterine ruptures, 93% received uterine stimulants for labor induction or augmentation. Compared with primary ruptures, secondary ruptures occurred at an earlier gestational age (P<0.001) and were associated with less blood loss (P=0.024). Uterine rupture resulted in the need for transfusion in 55%, hysterectomy in 27%, and maternal admission to the intensive care unit in 17%. Emergent delivery for maternal or fetal indications occurred with a decision to incision time averaging 10 minutes. Catastrophic neonatal outcomes were observed despite decision to incision times averaging 19 minutes for infants with acidemia, 17 minutes for infants with hypoxic ischemic encephalopathy, and 13 minutes for cases resulting in neonatal death.
Uterine rupture is a serious complication for women and their infants undergoing induction or augmentation of labor and for those pursuing a trial of labor after a cesarean delivery. Despite expedient decision to incision times, intrapartum uterine rupture may result in catastrophic perinatal outcomes.