Uterine rupture without previous caesarean delivery: a population-based cohort study.
OBJECTIVE
To determine incidence and patient characteristics of women with uterine rupture during singleton births at term without a previous caesarean delivery.


STUDY DESIGN
Population based cohort study. Women with term singleton birth, no record of previous caesarean delivery and planned vaginal delivery (n=611,803) were identified in the Danish Medical Birth Registry (1997-2008). Medical records from women recorded with uterine rupture during labour were reviewed to ascertain events of complete uterine rupture. Relative Risk (RR) and adjusted Relative Risk Ratio (aRR) of complete uterine rupture with 95% confidence intervals (95% CI) were ascertained according to characteristics of the women and of the delivery.


RESULTS
We identified 20 cases with complete uterine rupture. The incidence of complete uterine rupture among women without previous caesarean delivery was about 3.3/100,000 deliveries. Multiparity (RR 8.99 (95% CI 1.86-43.29)), induction of labour (RR 3.26 (95% CI 1.24-8.57)), epidural analgesia (RR 10.78 (95% CI 4.25-27.39)), and augmentation by oxytocin (RR 9.50 (95% CI 3.15-28.63)) were associated with uterine rupture. Induction of labour was not significantly related to uterine rupture when adjusted for parity, epidural analgesia and augmentation by oxytocin.


CONCLUSION
Although uterine rupture is rare, its association with epidural analgesia and augmentation of labour with oxytocin in multipara should be considered. Thus, vigilance should be exercised when labour is obstructed and there is need for epidural analgesia and/or augmentation by oxytocin in multiparous women. Due to the rare occurrence of uterine rupture caution should be exerted when interpreting the findings of this study.
['Thisted|Dorthe L A|DL|', 'Mortensen|Laust H|LH|', 'Krebs|Lone|L|']
D000328:Adult D015360:Analgesia, Epidural D016362:Analgesia, Obstetrical D002585:Cesarean Section D015331:Cohort Studies D003718:Denmark D005260:Female D006801:Humans D015994:Incidence D007751:Labor, Induced D010120:Oxytocics D010121:Oxytocin D010298:Parity D011247:Pregnancy D012042:Registries D012189:Retrospective Studies D014597:Uterine Rupture
Uterine rupture Multiparity Epidural analgesia Augmentation of labour Induced labour Spontaneous rupture