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Operative Obstetrics

Poster Session 1

(276) Pregnancy following Uterine Rupture - Maternal and Neonatal outcomes.

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary Author(s)

  • eliel shapira, MD (he/him/his)

    DR
    Shaare Zedek Medical Center, Hebrew University of Jerusalem
    Jerusalem, Yerushalayim, Israel

    • Presenting Author(s)

  • Tzuria Peled, MD (she/her/hers)

    Dr, OBGYN, SZMC
    Shaare Zedek Medical Center, Hebrew University of Jerusalem
    Jerusalem, Yerushalayim, Israel

    • Coauthor(s)

  • rF

    rivka Farkash, MPH

    Shaare Zedek Medical Center, Hebrew University of Jerusalem
    Jerusalem, Yerushalayim, Israel

  • HY

    Hen Y. Sela, MD

    Director maternity department D
    Shaare Zedek Medical Center, affiliated with the Hebrew University Hadassah School of Medicine
    Jerusalem, Israel, Israel

  • SG

    Sorina Grisaru-Granovsky, MD, PhD

    Shaare Zedek Medical Center, Hebrew University of Jerusalem
    Jerusalem, Yerushalayim, Israel

  • Maayan Bas Lando, MD

    Shaare Zedek Medical Center, Hebrew University of Jerusalem
    Jerusalem, Yerushalayim, Israel

Objective: Uterine rupture is a severe obstetrical complication that is associated with increased immediate maternal and neonatal morbidity. However, the literature regarding subsequent pregnancy outcome is scant and inconclusive. This study aims to investigate maternal and neonatal outcomes in the pregnancy following uterine rupture

Study Design: A multicenter retrospective study between 2005 to 2022 that included cases (exposed) of subsequent singleton pregnancies following uterine rupture- defined as a full-thickness defect in the uterine wall. Labor, maternal, and neonatal characteristics were compared to a matched control group (not exposed), in a ratio of 1 to 4 (maternal age, parity and number of previous CD) of subsequent pregnancies following previous CDs with no history of uterine rupture. main outcome: uterine rupture, secondary outcomes: other maternal and neonatal complications Statistics: Descriptive, means±SDs, medians+IQR. Comparisons: chi-square, Fisher's exact test, Mann-Whitney Test, multivariate logistic models

Results: During the study period there were 33 subsequent pregnancies following uterine rupture with one case of recurrent uterine rupture while the control group included 132 pregnancies without any event if uterine rupture (p=0.2). In the exposed group there were higher rates of composite adverse maternal outcomes (41.9% vs 18.6%; p=0.006), preterm delivery < 37 weeks (54.5% vs 10.6%; p< 0.001), NICU hospitalization >72 hours (29% vs 12.7%; p=0.026) and neonatal composite adverse outcomes (51.6% vs 30.4%; p=0.026
multivariate analysis revealed that previous uterine rupture was not associated with composite adverse neonatal outcome (OR= 1.085 95%CI [0.408-2.882] p=0.870). rather, the only association was found with preterm delivery < 37 weeks (OR=6.520 95%CI [2.257-18.838]; P< 0.001)

Conclusion: past uterine rupture is not associated with an increased risk of uterine rupture in the following pregnancy. However, other maternal and neonatal morbidities are increased mostly due to preterm delivery. Balancing timing of delivery vs concern for uterine rupture may improve obstetric outcomes