Fetus-Placenta-Newborn
Neonatal morbidity associated with uterine rupture: What are the risk factors?

https://doi.org/10.1067/mob.2002.119923Get rights and content

Abstract

Objective: The purpose of this study was to evaluate factors associated with severe metabolic acidosis or death in a situation of uterine rupture. Study Design: A retrospective study was performed with review of charts and electronic monitoring strips. Results: Between November 1988 and November 2000, a total of 23 cases of complete uterine rupture were identified from among 2233 trials of labor after a previous low transverse cesarean delivery. Nine neonates (39.1%) had severe metabolic acidosis (pH < 7.0); among these, hypoxic-ischemic encephalopathy was diagnosed in 3 neonates and another neonate died. Placental or fetal extrusion or both were associated with severe metabolic acidosis (P <.001) but not with the other factors (birth weight, induction of labor, use of oxytocin, use of epidural, and cervix dilatation). Two newborns with severe acidosis had impaired motor development even with an intervention time less than 18 minutes from the onset of prolonged deceleration to delivery. Conclusion: When uterine rupture occurs, placental or fetal extrusion was the most important factor associated with severe metabolic acidosis. Prompt intervention did not always prevent severe metabolic acidosis and neonatal morbidity. (Am J Obstet Gynecol 2002;186:311-4.)

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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Reprint requests: Robert J. Gauthier, MD, 3175 Côte Ste-Catherine, Montreal, Quebec, Canada H3T 1C5. E-mail: [email protected].

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