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Clinical Obstetrics

Poster Session 1

(223) Uterine rupture among patients with placenta accreta spectrum: pre-labor vs. in -labor

Tuesday, February 13, 2024

10:30 AM – 12:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Emi Komatsu, MD

Los Angeles General Hospital + USC Medical Center
Los Angeles, CA, United States

Coauthor(s)

SM

Shinya Matsuzaki, MD, PhD

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology
Osaka International Cancer Institute
Osaka, Osaka, Japan
Genevieve R. Mazza, MD

OB/GYN Resident Physician
Los Angeles General Hospital + USC Medical Center
Los Angeles, CA, United States
RM

Rachel S. Mandelbaum, MD

Los Angeles General Hospital + USC Medical Center
Los Angeles, CA, United States
DB

Doerthe Brueggmann, MD, PhD

University of Frankfurt Faculty of Medicine
Frankfurt, Hessen, Germany
JO

Joseph G. Ouzounian, MBA, MD

Professor and Chair of Obstetrics & Gynecology
Los Angeles General Hospital + USC Medical Center
Los Angeles, CA, United States
KM

Koji Matsuo, MD, PhD

Los Angeles General Hospital + USC Medical Center
Los Angeles, CA, United States

Objective: There is to date limited data examining uterine rupture in placental accreta spectrum (PAS). This study examined clinical and pregnancy characteristics related to uterine rupture among patients with PAS.

Study Design: This serial cross-sectional study queried the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population was 18,180 patients with diagnosis of PAS from 2017-2020. Patient and pregnancy characteristics were assessed for uterine rupture type (pre-labor or in-labor) in multivariable analysis.

Results: Uterine rupture occurred in 220 patients (12.1 per 1,000 PAS diagnoses), including 110 (6.1 per 1,000) pre-labor uterine ruptures and 110 (6.1 per 1,000) in-labor uterine ruptures. Patients who had pre-labor uterine rupture were older compared to those without uterine rupture (rupture (age ≥35 years, adjusted-odds ratio [aOR] 2.05, 95% confidence interval [CI] 1.37-3.05). Patients with placenta percreta were four times more likely to have pre-labor uterine rupture compared to those with placenta accreta (adjusted-odds ratio [aOR] 4.26, 95% confidence interval [CI] 2.81-6.46). Prior vertical or low-transverse uterine incision was not associated with pre- or in-labor uterine rupture. Pre-labor uterine rupture occurred more in extreme-preterm (< 28 vs ≥36 weeks, aOR 13.35, 95%CI 6.71-26.57) followed by early-preterm (28-35 vs ≥36 weeks, aOR 5.61, 95%CI 3.09-10.16). In-labor uterine rupture occurred more in extreme-preterm (aOR 2.66, 95%CI 1.38-5.14) but not in early-preterm (aOR 1.28, 95%CI 0.81-2.03). Pre-labor uterine rupture, but not in-labor uterine rupture, was associated with fetal demise or stillbirth (aOR 3.69, 95%CI 1.93-7.05).

Conclusion: This nationwide analysis suggests that uterine rupture can occur in one in nearly 80 patients with PAS and that pre- and in-labor uterine ruptures have distinct differences in clinical and pregnancy characteristics.