Fetus-Placenta-NewbornNeonatal morbidity associated with uterine rupture: What are the risk factors?☆
Section snippets
Methods
The study was conducted at Ste-Justine Hospital, a tertiary care hospital with in-house obstetricians and anesthesiologists. All medical records of patients who underwent a trial of labor after a previous low transverse cesarean delivery at Ste-Justine Hospital in the period from November 1988 to November 2000 were reviewed. We retained those records that presented a complete uterine rupture, which was defined as a uterine scar separation with the overlying visceral peritoneum (uterine serosa)
Results
Between November 1988 and November 2000, there were 48,470 deliveries in our tertiary care institution. Of these, 4718 women had undergone a previous low transverse cesarean delivery and 2233 women (47.3%) had had a trial of labor. Twenty-three patients (1.0%) had experienced complete uterine rupture, and 6 of those women (26.1%) had a complete extrusion of the fetus or placenta in the abdominal cavity (1 with the placenta completely outside the uterus and the fetus partially out, 1 with only
Comment
Severe metabolic acidosis was present in 9 (37%) of 23 neonates of women with uterine ruptures. In this group, 3 newborns had hypoxic-ischemic encephalopathies and a fourth one died during birth.
As in the study by Leung et al,7 we found that the most important factor of acidosis is the complete extrusion of the fetus and placenta into the maternal abdomen. Contrary to that report, 2 neonates had hypoxic-ischemic encephalopathies with impaired motor development, even with an intervention time of
Acknowledgements
We thank Camille Bujold, OT, Amanda Skoll, MD, and Francois Harel, MSc, for their valuable contributions to this project.
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