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CC BY 4.0 · Rev Bras Ginecol Obstet 2021; 43(11): 820-825
DOI: 10.1055/s-0041-1739461
Original Article
Obstetrics

Risk Factors Associated with Uterine Rupture and Dehiscence: A Cross-Sectional Canadian Study

Fatores de risco associados à ruptura uterina e deiscência: Um estudo transversal canadense
Ernesto Antonio Figueiró-Filho 
1   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
,
Javier Mejia Gomez 
2   Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
,
Dan Farine 
1   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Abstract

Objective To compare maternal and perinatal risk factors associated with complete uterine rupture and uterine dehiscence.

Methods Cross-sectional study of patients with uterine rupture/dehiscence from January 1998 to December 2017 (30 years) admitted at the Labor and Delivery Unit of a tertiary teaching hospital in Canada.

Results There were 174 (0.1%) cases of uterine disruption (29 ruptures and 145 cases of dehiscence) out of 169,356 deliveries. There were associations between dehiscence and multiparity (odds ratio [OR]: 3.2; p = 0.02), elevated maternal body mass index (BMI; OR: 3.4; p = 0.02), attempt of vaginal birth after a cesarian section (OR: 2.9; p = 0.05) and 5-minute low Apgar score (OR: 5.9; p < 0.001). Uterine rupture was associated with preterm deliveries (36.5 ± 4.9 versus 38.2 ± 2.9; p = 0.006), postpartum hemorrhage (OR: 13.9; p < 0.001), hysterectomy (OR: 23.0; p = 0.002), and stillbirth (OR: 8.2; p < 0.001). There were no associations between uterine rupture and maternal age, gestational age, onset of labor, spontaneous or artificial rupture of membranes, use of oxytocin, type of uterine incision, and birthweight.

Conclusion This large cohort demonstrated that there are different risk factors associated with either uterine rupture or dehiscence. Uterine rupture still represents a great threat to fetal-maternal health and, differently from the common belief, uterine dehiscence can also compromise perinatal outcomes.

Resumo

Objetivo Comparar os fatores de risco maternos e perinatais associados à ruptura uterina completa e deiscência uterina.

Métodos Estudo transversal de pacientes com ruptura/deiscência uterina no período de janeiro de 1998 a dezembro de 2017 (30 anos) internadas na Unidade de Parto de um hospital universitário terciário no Canadá.

Resultados Ocorreram 174 (0,1%) casos de transtorno uterino (29 rupturas e 145 deiscências) em 169.356 partos. Houve associações entre deiscência e multiparidade (razão de chances [RC]: 3,2; p = 0,02), índice de massa corporal (IMC) materno elevado (RC: 3,4; p = 0,02), tentativa de parto vaginal após cesariana (RC: 2,9; p = 0,05) e baixa pontuação Apgar em 5 minutos (RC: 5,9; p < 0,001). A ruptura uterina foi associada a partos prematuros (36,5 ± 4,9 versus 38,2 ± 2,9; p = 0,006), hemorragia pós-parto (RC: 13,9; p < 0,001), histerectomia (RC: 23,0; p = 0,002) e natimorto (RC: 8,2; p < 0,001). Não houve associação entre ruptura uterina e idade materna, idade gestacional, início do trabalho de parto, ruptura espontânea ou artificial de membranas, uso de ocitocina, tipo de incisão uterina e peso ao nascer.

Conclusão Esta grande coorte demonstrou que existem diferentes fatores de risco associados à ruptura ou à deiscência uterina. A ruptura uterina ainda representa uma grande ameaça à saúde materno-fetal e, diferentemente da crença comum, a deiscência uterina também pode comprometer os desfechos perinatais.

Keywords

urupture - dehiscence - relative risk - cross-sectional - perinatal outcomes

Palavras-chave

ruptura uterina - deiscência - risco relativo - transversal - resultados perinatais

Contributions

EAFF, JMG and DF contributed equally to the manuscript. EAFF was responsible for the conception and design, acquisition of data, analysis and interpretation of data, drafting the article, and gave final approval to the version to be submitted. JMG contributed by drafting the article and revising it critically for important intellectual content, and gave final approval to the version to be submitted. DF contributed to the analysis and interpretation of data, drafting the article, and gave final approval to the version to be submitted.




Publication History

Received: 06 December 2020

Accepted: 15 September 2021

Article published online:
06 December 2021

© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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