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Uterine rupture in the Netherlands: A nationwide population-based cohort study

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Author: Zwart, J.J. · Richters, J.M. · Öry, F. · Vries, J.I.P. de · Bloemenkamp, K.W.M. · Roosmalen, J. van
Type:article
Date:2009
Source:BJOG: An International Journal of Obstetrics and Gynaecology, 8, 116, 1069-1078
Identifier: 241621
doi: doi:10.1111/j.1471-0528.2009.02136.x
Keywords: Health · Incidence · Population based · Unscarred uterus · Uterine rupture · VBAC · Misoprostol · Oxytocin · Prostaglandin · Prostaglandin E2 · Sulprostone · Abdominal pain · Africa · Cesarean section · Cohort analysis · Epidural anesthesia · Ethnic group · Ethnicity · Far East · Major clinical study · Maternal morbidity · Maternal mortality · Middle ear · Middle East · Morocco · Muscle hypertonia · Newborn morbidity · Newborn mortality · Obesity · Pregnancy termination · Scar · Suriname · Turkey (republic) · Vagina bleeding · Western Europe · Adult · Cicatrix · Delivery, Obstetric · Female · Humans · Middle Aged · Netherlands · Pregnancy · Prospective Studies · Risk Factors · Socioeconomic Factors · Trial of Labor · Uterine Rupture · Vaginal Birth after Cesarean · Young Adult

Abstract

Objective: To assess incidence of uterine rupture in scarred and unscarred uteri and its maternal and fetal complications in a nationwide design. Design: Population-based cohort study. Setting: All 98 maternity units in the Netherlands. Population: All women delivering in the Netherlands between August 2004 and August 2006 (n = 371 021). Methods: Women with uterine rupture were prospectively collected using a web-based notification system. Data from all pregnant women in the Netherlands during the study period were obtained from Dutch population-based registers. Results: were stratified by uterine scar. Main outcome measures: Population-based incidences, severe maternal and neonatal morbidity and mortality, relative and absolute risk estimates. Results: There were 210 cases of uterine rupture (5.9 per 10 000 pregnancies). Of these women, 183 (87.1%) had a uterine scar, incidences being 5.1 and 0.8 per 10 000 in women with and without uterine scar. No maternal deaths and 18 cases of perinatal death (8.7%) occurred. The overall absolute risk of uterine rupture was 1 in 1709. In univariate analysis, women with a prior caesarean, epidural anaesthesia, induction of labour (irrespective of agents used), pre- or post-term pregnancy, overweight, non-Western ethnic background and advanced age had an elevated risk of uterine rupture. The overall relative risk of induction of labour was 3.6 (95% confidence interval 2.7-4.8). Conclusion: The population-based incidence of uterine rupture in the Netherlands is comparable with other Western countries. Although much attention is paid to scar rupture associated with uterotonic agents, 13% of ruptures occurred in unscarred uteri and 72% occurred during spontaneous labour. © RCOG 2009 BJOG An International Journal of Obstetrics and Gynaecology. Chemicals / CAS: misoprostol, 59122-46-2, 59122-48-4; oxytocin, 50-56-6, 54577-94-5; prostaglandin E2, 363-24-6; sulprostone, 60325-46-4, 96420-78-9