Analysis of the uterine rupture during pregnancy and delivery in a provincial maternal and children care hospital in China: 2013-2022.

Background: Uterine rupture is rare and life-threatening for both mothers and newborns. This study aimed to explore the clinical manifestation, site of rupture, obstetric risk factors, maternal and neonatal complications, and birth outcomes with mid-trimester and late-pregnancy uterine rupture.

Methods: Data from patients with uterine rupture occurring at Hunan Maternal and Child Health Hospital between January 2013 and December 2022 were reviewed retrospectively.

Results: 153,722 deliveries occurred during the 10 years of the study period. A total number of 129 uterine ruptures were identified: 12 ruptures occurred in the second trimester and 117 cases of uterine rupture diagnosed at or after 28 weeks gestation. The total incidence was 8.4/10,000. Most of the patients had a history of cesarean section (73.6%). 59.7% cases had a history of dilation and curettage. The rupture was more likely to occur on the lower uterine segment (86.82%). Seventy-one patients (55%) presented with abdominal pain or vaginal bleeding. Twenty-seven (20.9%) cases underwent a labor trial. There were 17 perinatal deaths associated with uterine rupture and neonatal asphyxia was observed in five infants. There was one maternal death. Postpartum hemorrhage occurred in 25 cases. Five patients underwent hysterectomy. Patients with uterine rupture during mid-trimester were more likely to receive a blood transfusion and exhibited higher rates of bladder injury.

Conclusion: Uterine rupture especially mid-gestational uterine rupture is rare and remains a diagnostic challenge. Remarkably worse maternal outcomes were seen in patients with second-trimester rupture when compared with patients who experienced late-pregnancy rupture. Pregnant women with a history of uterine surgery, even at an early gestational age, should be closely monitored by obstetricians for the risk of uterine rupture if they experience persistent abdominal pain. Early recognition and prompt intervention are key to improve maternal and child outcomes.