Uterine Rupture at 21 Weeks in Twin Pregnancy with TTTS and Previous C-Section.
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SUBMITTER: Bhikha-Kori G
PROVIDER: S-EPMC5559912 | biostudies-other | 2017
REPOSITORIES: biostudies-other
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Project description:ObjectiveTo evaluate the incidence and consequences of uterine rupture in women who have had a delivery by caesarean section.DesignSystematic review.Data sourcesMedline, HealthSTAR, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, National Centre for Reviews and Dissemination, reference lists, and national experts. Studies in all languages were eligible if published in full.Review methodsMethodological quality was evaluated for each study by using criteria from the United States Preventive Services Task Force and the National Health Service Centre for Reviews and Dissemination. Uterine rupture was categorised as asymptomatic or symptomatic.ResultsWe reviewed 568 full text articles to identify 71 potentially eligible studies, 21 of which were rated at least fair in quality. Compared with elective repeat caesarean delivery, trial of labour increased the risk of uterine rupture by 2.7 (95% confidence interval 0.73 to 4.73) per 1000 cases. No maternal deaths were related to rupture. For women attempting vaginal delivery, the additional risk of perinatal death from rupture of a uterine scar was 1.4 (0 to 9.8) per 10,000 and the additional risk of hysterectomy was 3.4 (0 to 12.6) per 10 000. The rates of asymptomatic uterine rupture in trial of labour and elective repeat caesarean did not differ significantly.ConclusionsAlthough the literature on uterine rupture is imprecise and inconsistent, existing studies indicate that 370 (213 to 1370) elective caesarean deliveries would need to be performed to prevent one symptomatic uterine rupture.
| S-EPMC443444 | biostudies-literature
Project description:Background The maternal and fetal risks of uterine distension in rapidly progressive twin-twin transfusion syndrome (TTTS) in the setting of prior uterine scar are poorly characterized. Case We present the case of a 42-year-old woman, G4P1201, at 21 weeks gestation with stage-1 TTTS who developed a spontaneous posterior uterine rupture necessitating emergent laparotomy and delivery of previable fetuses, possibly due to prior uterine scar from a displaced intrauterine device. Conclusion TTTS may be a risk factor for uterine rupture, including uterine rupture in atypical anatomic locations. Prior unrecognized uterine scars, including perforations, may magnify the risk for atypical uterine rupture in the setting of excessive uterine distension.
| S-EPMC4737637 | biostudies-other
Project description:ObjectiveTo study the outcomes of new pregnancies after a previous complete uterine rupture.DesignDescriptive study based on population data from the Medical Birth Registry of Norway, the Patient Administration System, and the medical records. Sample. Maternities with a previous complete uterine rupture in Norway during the period 1967-2011 (N = 72), extracted from 2 455 797 maternities.MethodWe measured the rate of new complete ruptures and partial ruptures, as well as the maternal and perinatal outcomes of these pregnancies. The characteristics of both previous ruptures and new ruptures were described.ResultsAmong 72 maternities, there were thirty-seven with previous ruptures in the lower segment (LS) and 35 outside the LS. We found three new complete ruptures and six uneventful partial ruptures, resulting in a rate of 4.2% and 8.3%, respectively. All three complete ruptures occurred preterm in scars outside the LS. The rate of the new complete rupture was 0% in those with previous ruptures in the LS and 8.6% in those with previous ruptures outside the LS. The corrected perinatal mortality was 1.3%, and prematurity (<37 weeks) was high (36.1%); this was noticed even in the absence of new ruptures and was mostly iatrogenic. Two hysterectomies were performed in the absence of rupture and two cases had abnormal invasive placenta.ConclusionThe prognosis for pregnancies after a previous complete uterine rupture is favorable. Prematurity is a problem caused by both obstetrician and mother's anxiety; therefore, the timing of delivery is the most challenging. Management should include careful counseling, vigilance for symptoms, and immediate delivery when a rupture is suspected.
| S-EPMC9935781 | biostudies-literature
Project description:ObjectivesLittle is known about the motivations to apply for emergency contraception (EC). Our first aim was to explore the motivating circumstances to use EC as fast as possible. Our second aim was to explore the contraceptive method of the population seeking EC.Study designThis present retrospective observational study between July 2021 and September 2021 is embedded in the MEEC (Motivation and Epidemiology of Emergency Contraceptive Pill) based on the study cohort of a Hungarian data bank containing follow-up data of 455 women applied for EC telemedicine consultation. Variables assessed were: age, gynecological history (pregnancies, abortions, miscarriages), data of the intercourse (elapsed time, contraceptive method), and data of the menstrual cycle, and relationship status.ResultsOf all patients, 59.3 % reported condom rupture, 29.5 % no protection, and 11.2 % other. Patients using condom applied for EC significantly sooner than those using no protection and using other protective methods. A significantly shorter elapsed time was observed in patients with a history of a previous pregnancy. No significant relationship was seen between the way of protection, previous pregnancies, and surprisingly the time of ovulation despite the obvious intention of avoiding pregnancy.ConclusionsThis is the first study to examine the potential role of epidemiologic factors as motivators for EC on the basis of a large patient cohort. Our study demonstrates the significant role of condom rupture/use and the history of previous pregnancies to be the strongest motivators for EC.
| S-EPMC10772218 | biostudies-literature
Project description:The incidence of uterine rupture through a previous cesarean scar (CS) is declining as a result of a lower parity and fewer options for vaginal birth after cesarean. However, uterine ruptures attributable to other causes that traumatize the myometrium are on the rise. To determine whether changes in the causes of uterine rupture had occurred in recent years, we retrospective retrieved the clinical records of all singletons with uterine rupture observed in the delivery room of a Taiwanese tertiary obstetric center over a 15-year period. The overall uterine rupture rate was 3.8 per 10,000 deliveries. A total of 22 cases in 20 women (with two of them experiencing two episodes). Seven uterine ruptures occurred through a previous cesarean scar (CS ruptures, 32%), 13 through a non-cesarean scar (non-CS ruptures, 59%), whereas the remaining two (9%) were in women who did not previously undergo any surgery. All of the 13 non-CS ruptures were identified in women with a history of laparoscopic procedures to the uterus. Specifically, 10 (76%) occurred after a previous laparoscopic myomectomy, one (8%) following a hysteroscopic myomectomy, and two (16%) after a laparoscopic wedge resection of cornual ectopic pregnancy. Severe bleeding (blood loss >1500 mL) requiring transfusions was more frequent in women who experienced non-CS compared with CS ruptures (10 versus 1 case, respectively, P = 0.024). Patients with a history of endoscopic uterine surgery should be aware of uterine rupture during pregnancy.
| S-EPMC5963787 | biostudies-literature
Project description:BackgroundShort interpregnancy interval (IPI) following caesarean delivery is associated with uterine rupture in subsequent pregnancies. However, the interval required to minimise this risk is unknown. We investigated how the interval between pregnancies and induction or augmentation of labour affect the likelihood of uterine rupture among parturients with one previous livebirth by caesarean delivery who had a subsequent trial of labour.MethodsIn this population-based cohort study, we used data from U.S National Vital Statistics System from 2011 to 2021. Multiple pregnancies and births of infants with congenital abnormalities were excluded. A linear spline logistic regression with one knot was used to assess the relationship between uterine rupture and interpregnancy interval for spontaneous and for induced/augmented labours. Multivariable logistic regression was performed with multiple imputation and stepwise backward elimination to adjust for maternal demographic and clinical factors including maternal age, height, and BMI and gestational age. The predicted risk of uterine rupture was tabulated for interpregnancy intervals between zero and 21 months. Adverse outcomes were compared between labours with and without uterine rupture.FindingsWe examined 491,998 trials of labour among parturients with one previous livebirth by caesarean delivery and no previous vaginal births. The odds ratio (OR) of uterine rupture per three months interpregnancy interval was 0.91 (95% CI 0.88-0.94) between zero and 21 months after adjusting for confounders, with no further change in risk detected beyond 21 months. The OR was 2.51 (95% CI 2.27-2.78) for induced or augmented labours compared with spontaneous labours. Other factors associated with uterine rupture included older maternal age, shorter maternal height, more advanced gestational age (from 35 to 43 weeks), and heavier birthweight. Predicted rates of uterine rupture ranged from 0.36% at zero to 0.19% at 21 months' interpregnancy interval for spontaneous labours and from 0.91% to 0.47% for induced/augmented labours for parturients with a typical clinical and demographic background. When uterine rupture occurred, the rates of unplanned hysterectomy, intrapartum or neonatal death, and neonatal seizures were 4.0% (95% CI 3.2-5.1%), 3.7% (95% CI 2.7-5.1%), and 2.6% (95% CI 1.8-3.3%) respectively.InterpretationThe risk of uterine rupture progressively decreases as IPI increases until about 21 months and then stabilises. Counselling should advise that for women choosing between a planned TOLAC or a planned caesarean delivery after one previous caesarean delivery and no previous vaginal births waiting until 21 months or longer after a prior low transverse caesarean delivery might minimise the risk of uterine rupture. The absolute risk of certain serious maternal and fetal/neonatal complications such as unplanned hysterectomy and perinatal death is low.FundingNo funding.
| S-EPMC11788787 | biostudies-literature
Project description: Not available
| S-EPMC4620992 | biostudies-literature
Project description:RationaleUterine rupture is extremely hazardous to both mothers and infants. Diagnosing silent uterine rupture in pregnant women without uterine contractions is challenging due to the presence of nonspecific symptoms, signs, and laboratory indicators. Therefore, it is crucial to identify the elevated risks associated with silent uterine rupture.Patient concernson admission, case 1 was at 37 gestational weeks, having undergo laparoscopic transabdominal cerclage 8 months prior to the in vitro fertilization embryo transfer procedure, case 2 was at 38 4/7 gestational weeks with a history of 5 previous artificial abortion and 2 previous vaginal deliveries, case 3 was at 37 6/7 gestational weeks with a history of laparoscopic myomectomy.DiagnosesThe diagnosis of silent uterine rupture was based on clinical findings from cesarean delivery or laparoscopic exploration.InterventionsCase 1 underwent emergent cesarean delivery, revealing a 0.25 cm × 0.25 cm narrow concave area above the Ring Ties with active and bright amniotic fluid flowing from the tear. Case 2 underwent vaginal delivery, and on the 12th postpartum day, ultrasound imaging and magnetic resonance imaging revealed a 5.8 cm × 3.3 cm × 2.3 cm lesion on the lower left posterior wall of the uterus, and 15th postpartum day, laparoscopic exploration confirmed the presence of an old rupture of uterus. Case 3 underwent elective cesarean delivery, revealing a 3.0 cm × 2.0 cm uterine rupture without active bleeding at the bottom of the uterus.OutcomesThe volumes of antenatal bleeding for the 3 patients were approximately 500 mL, 320 mL, and 400 mL, respectively. After silent uterine ruptures were detected, the uterine tear was routinely repaired. No maternal or neonatal complications were reported.LessonsObstetricians should give particular consideration to the risk factors for silent uterine rupture, including a history of uterine surgery, such as laparoscopic transabdominal cerclage, laparoscopic myomectomy, and induced abortion.
| S-EPMC10919461 | biostudies-literature
Project description:Transabdominal cerclage (TAC) is reported to be effective for preventing preterm birth in women with unsuccessful transvaginal cerclage (TVC) history. However, TAC has rarely been performed in twin pregnancy given the lack of sufficient evidence and the technical difficulty of the operation. Thus, it is unclear whether TAC is an effective procedure for twin pregnancy in women with a history of unsuccessful TVC. The aim of this study is to compare the characteristics and pregnancy outcomes after TAC in twin pregnancy versus singleton pregnancy, to examine whether twin pregnancy is a risk factor for very preterm birth (before 32 weeks) after TAC, and to determine whether TAC is effective in preventing preterm birth in twin pregnancy. This single-center retrospective cohort study included women who underwent TAC because of unsuccessful TVC history between January 2007 and June 2018. Of 165 women who underwent TAC, 19 had twins and 146 had singletons. Our results showed that the neonatal survival rate improved dramatically when TAC was performed (15.4% (prior pregnancy) vs 94.0% (after TAC) in twins, p<0.01; 22.8% (prior pregnancy) vs 91.1% (after TAC) in singletons, p<0.01). Moreover, the risk of very preterm birth was significantly decreased after TAC in both groups (36/39 (92.3%) (prior pregnancy) vs 2/19 (10.5%) (after TAC) in twins, p<0.01; 290/337 (86.1%) (prior pregnancy) vs 17/146 (11.6%) (after TAC) in singletons, p<0.01). More advanced maternal age and history of prior preterm delivery between 26+0 and 36+6 weeks were independently associated with very preterm birth, whereas the presence of a twin pregnancy was not associated with very preterm birth on multivariate logistic regression analysis. These results suggest that TAC is associated with successful prevention of very preterm birth and improved neonatal survival rates in the absence of procedure-related major complications in women with twin pregnancy and previous unsuccessful TVC history.
| S-EPMC7192486 | biostudies-literature
Project description:Although the blunt uterine incision expansion during a low-transverse cesarean delivery has prevailed over the sharp technique, the latter should not be completely abandoned. The sharp method with scissors should be considered when managing patients with previous cesarean sections, although more studies are required for a definite answer.
| S-EPMC9587506 | biostudies-literature