Uterine rupture in first versus second stage of labour—A case‐series study in a tertiary referral centre

Abstract

Abstract Introduction To analyse at what point during delivery, and during what clinical circumstances uterine rupture occurs. Uterine rupture is a rare peripartum complication associated with severe outcome for both mother and child. To date, many studies have characterized potential risk factors to uterine rupture, however, the intrapartum course remains unclear. Material and Methods A case‐series study based on data collected from patient data records on all women with uterine rupture at a tertiary referral centre between 2008 and 2019. Data were compared on women with uterine rupture during first versus second stage of labour, and women with spontaneous onset versus induced labour. Results A total of 109 women were included, whereof 94.5% had one or more previous caesarean deliveries. Uterine rupture occurred during the whole course of labour. Women with uterine rupture during second stage of labour (n = 46) compared to women with uterine rupture during first stage of labour (n = 63), were more exposed to oxytocin (p < 0.0001), tended to use epidural anaesthesia more often during delivery (p = 0.053), had larger mean volume of haemorrhage (p = 0.015), and tended to have a higher occurrence of low Apgar score (p = 0.051) and asphyxia in the infant (p = 0.04). Women with induced labour (n = 42) tended to have shorter time‐to‐uterine‐rupture than women with spontaneous onset (n = 67) (p = 0.055). Conclusions Uterine rupture occur both in first and second stage of labour. Maternal and infant outcomes are worse when uterine rupture occurs in the second stage of labour. These results emphasize the importance of a close monitoring during the whole course of delivery.

Keywords

• labour
• trial of labour after caesarean
• uterine rupture