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Uterine rupture in The Netherlands: a nationwide population-based cohort study.
BJOG. 2009 Jul; 116(8):1069-78; discussion 1078-80.BJOG

Abstract

OBJECTIVE

To assess incidence of uterine rupture in scarred and unscarred uteri and its maternal and fetal complications in a nationwide design.

DESIGN

Population-based cohort study.

SETTING

All 98 maternity units in The Netherlands.

POPULATION

All women delivering in The Netherlands between August 2004 and August 2006 (n = 371,021).

METHODS

Women with uterine rupture were prospectively collected using a web-based notification system. Data from all pregnant women in The Netherlands during the study period were obtained from Dutch population-based registers. Results were stratified by uterine scar.

MAIN OUTCOME MEASURES

Population-based incidences, severe maternal and neonatal morbidity and mortality, relative and absolute risk estimates.

RESULTS

There were 210 cases of uterine rupture (5.9 per 10,000 pregnancies). Of these women, 183 (87.1%) had a uterine scar, incidences being 5.1 and 0.8 per 10,000 in women with and without uterine scar. No maternal deaths and 18 cases of perinatal death (8.7%) occurred. The overall absolute risk of uterine rupture was 1 in 1709. In univariate analysis, women with a prior caesarean, epidural anaesthesia, induction of labour (irrespective of agents used), pre- or post-term pregnancy, overweight, non-Western ethnic background and advanced age had an elevated risk of uterine rupture. The overall relative risk of induction of labour was 3.6 (95% confidence interval 2.7-4.8).

CONCLUSION

The population-based incidence of uterine rupture in The Netherlands is comparable with other Western countries. Although much attention is paid to scar rupture associated with uterotonic agents, 13% of ruptures occurred in unscarred uteri and 72% occurred during spontaneous labour.

Authors+Show Affiliations

Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands. j.j.zwart@lumc.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19515148

Citation

Zwart, J J., et al. "Uterine Rupture in the Netherlands: a Nationwide Population-based Cohort Study." BJOG : an International Journal of Obstetrics and Gynaecology, vol. 116, no. 8, 2009, pp. 1069-78; discussion 1078-80.
Zwart JJ, Richters JM, Ory F, et al. Uterine rupture in The Netherlands: a nationwide population-based cohort study. BJOG. 2009;116(8):1069-78; discussion 1078-80.
Zwart, J. J., Richters, J. M., Ory, F., de Vries, J. I., Bloemenkamp, K. W., & van Roosmalen, J. (2009). Uterine rupture in The Netherlands: a nationwide population-based cohort study. BJOG : an International Journal of Obstetrics and Gynaecology, 116(8), 1069-78; discussion 1078-80. https://doi.org/10.1111/j.1471-0528.2009.02136.x
Zwart JJ, et al. Uterine Rupture in the Netherlands: a Nationwide Population-based Cohort Study. BJOG. 2009;116(8):1069-78; discussion 1078-80. PubMed PMID: 19515148.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Uterine rupture in The Netherlands: a nationwide population-based cohort study. AU - Zwart,J J, AU - Richters,J M, AU - Ory,F, AU - de Vries,J I P, AU - Bloemenkamp,K W M, AU - van Roosmalen,J, PY - 2009/6/12/entrez PY - 2009/6/12/pubmed PY - 2009/8/12/medline SP - 1069-78; discussion 1078-80 JF - BJOG : an international journal of obstetrics and gynaecology JO - BJOG VL - 116 IS - 8 N2 - OBJECTIVE: To assess incidence of uterine rupture in scarred and unscarred uteri and its maternal and fetal complications in a nationwide design. DESIGN: Population-based cohort study. SETTING: All 98 maternity units in The Netherlands. POPULATION: All women delivering in The Netherlands between August 2004 and August 2006 (n = 371,021). METHODS: Women with uterine rupture were prospectively collected using a web-based notification system. Data from all pregnant women in The Netherlands during the study period were obtained from Dutch population-based registers. Results were stratified by uterine scar. MAIN OUTCOME MEASURES: Population-based incidences, severe maternal and neonatal morbidity and mortality, relative and absolute risk estimates. RESULTS: There were 210 cases of uterine rupture (5.9 per 10,000 pregnancies). Of these women, 183 (87.1%) had a uterine scar, incidences being 5.1 and 0.8 per 10,000 in women with and without uterine scar. No maternal deaths and 18 cases of perinatal death (8.7%) occurred. The overall absolute risk of uterine rupture was 1 in 1709. In univariate analysis, women with a prior caesarean, epidural anaesthesia, induction of labour (irrespective of agents used), pre- or post-term pregnancy, overweight, non-Western ethnic background and advanced age had an elevated risk of uterine rupture. The overall relative risk of induction of labour was 3.6 (95% confidence interval 2.7-4.8). CONCLUSION: The population-based incidence of uterine rupture in The Netherlands is comparable with other Western countries. Although much attention is paid to scar rupture associated with uterotonic agents, 13% of ruptures occurred in unscarred uteri and 72% occurred during spontaneous labour. SN - 1471-0528 UR - https://www.unboundmedicine.com/medline/citation/19515148/Uterine_rupture_in_The_Netherlands:_a_nationwide_population_based_cohort_study_ L2 - https://doi.org/10.1111/j.1471-0528.2009.02136.x DB - PRIME DP - Unbound Medicine ER -