Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population-based study of successive pregnancies in Sweden
Article first published online: 12 SEP 2007
RCOG 2007 BJOG An International Journal of Obstetrics and Gynaecology
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 114, Issue 10, pages 1208–1214, October 2007
How to Cite
Kaczmarczyk, M., Sparén, P., Terry, P. and Cnattingius, S. (2007), Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population-based study of successive pregnancies in Sweden. BJOG: An International Journal of Obstetrics & Gynaecology, 114: 1208–1214. doi: 10.1111/j.1471-0528.2007.01484.x
- Issue published online: 12 SEP 2007
- Article first published online: 12 SEP 2007
- Accepted 3 July 2007.
- Caesarean section;
- cohort study;
- infant mortality;
- uterine rupture;
- vaginal birth after caesarean
Objective Uterine rupture is a rare but a catastrophic event. The aim of the present study was to explore the risk factors for uterine rupture and associated neonatal morbidity and mortality among a cohort of Swedish women attempting vaginal birth in their second delivery.
Design Population-based cohort study.
Population A total of 300 200 Swedish women delivering two single consecutive births between 1983 and 2001.
Methods Swedish population-based registers were used to obtain information concerning demographics, pregnancy and birth characteristics, and neonatal outcomes. Logistic regression was used to analyse potential risk factors for uterine rupture and risk of neonatal mortality associated with uterine rupture. Odds ratios were used to estimate relative risks using 95% CI.
Main outcome measure Uterine rupture and neonatal mortality in the second pregnancy.
Results Compared with women who delivered vaginally in their first birth, women who underwent a caesarean delivery were, during their second delivery, at increased risk of uterine rupture (adjusted OR 41.79; 95% CI 29.73–57.00). Induction of labour, high (≥4000 g) birthweight, postterm (≥42 weeks) births, high (≥35 years) maternal age, and short (≤164 cm) maternal stature were also associated with increased risk of uterine rupture. Uterine rupture was associated with a substantially increased risk in neonatal mortality (adjusted OR 65.62; 95% CI 32.60–132.08).
Conclusion The risk of uterine rupture in subsequent deliveries is not only markedly increased among women with a previous caesarean delivery but also influenced by induction of labour, birthweight, gestational age, and maternal characteristics.