Uterine rupture: timing of diagnosis affects maternal outcomes

  • Rottenstreich M & al.
  • J Matern Fetal Neonatal Med
  • 15 May 2019

  • International Clinical Digest
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Takeaway

  • Timing of diagnosis of uterine rupture affects maternal morbidity, and classic signs of the condition are not always detected, delaying diagnosis.

Why this matters

  • Uterine rupture occurs most commonly during labor.  
  • It should be suspected if operative vaginal delivery is performed and there are signs of hemorrhage, hypotension, or pain.

Key results

  • Rate of uterine rupture was 0.08%.
  • 79.7% were diagnosed intrapartum and 20.3% delayed diagnosis.
  • Intrapartum diagnosis:
    • Most diagnosed in latent phase (63.2%).
    • Median time from delivery to diagnosis was 4.5 hours.
  • Delayed diagnosis more likely with:
    • Older and multiparous women.
    • Unscarred uterus (P<.001>
    • Induction (P<.001>
    • Epidural (P<.001>
    • Operative vaginal delivery because of concern over fetal heart tones.
  • Delay is associated with increased maternal morbidity (P=.001).
  • No difference in neonatal outcomes between groups.

Study design

  • Retrospective cohort study.
  • Women with a singleton pregnancy diagnosed with uterine rupture between 2005 and 2018 were included (N=143).
  • Women were stratified into 1 of 2 groups: diagnosis made intrapartum/intraoperatively (n=114) and diagnosis after vaginal delivery (n=29).
  • Funding: None disclosed.

Limitations

  • Timing of uterine rupture in the 2 groups was different and could have affected overall outcomes.

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