The risk factors of complete uterine rupture: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LIN Chunrong ^1,2 , LIU Guangyu ¹ , CAO Tiantian ¹ ,  LIU Xinghui ¹

1. Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu 610041, P.R.China;
2. Department of Obstetrics and Gynecology, Mianyang Central Hospital, Mianyang 621000, P.R.China;

Corresponding author：

LIU Xinghui, Email: xinghuiliu@163.com

Keywords：

Pregnancy; Complete uterine rupture; Risk factor; Systematic review; Meta-analysis; Case-control study; Cohort study

DOI：

10.7507/1672-2531.202006145

Video：

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Objectives To systematically review the risk factors of complete uterine rupture so as to provide evidence for prevention of uterine rupture.Methods PubMed, EMbase, The Cochrane Library, CBM and CNKI databases were electronically searched to collect case-control studies or cohort studies on the risk of complete uterine rupture from inception to October, 2019. Two reviewers independently screened literature, extracted data and assessed the quality of included studies, then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 18 studies, involving 2 104 607 cases were included. The results of meta-analysis showed that the risk factors of complete uterine rupture included single-layer suture of uterine incision (OR=1.78, 95%CI 1.15 to 2.78, P=0.01), induction of labor (OR=1.72, 95%CI 1.21 to 2.45, P=0.003) (case-control studies) and (OR=2.66, 95%CI 1.87 to 3.79, P<0.000 01) (cohort studies), induction with prostaglandins (OR=3.23, 95%CI 1.48 to 7.06, P=0.003), induction with oxytocin (OR=3.97, 95%CI 1.65 to 9.59, P=0.002), and augmentation of labor with oxytocin (OR=2.17, 95%CI 1.53 to 3.09, P<0.000 1) (case-control studies) and (OR=2.29, 95%CI 1.24 to 4.23, P=0.008) (cohort studies). There was no significant relationship between birth weight and complete uterine rupture (OR=1.26, 95%CI 0.74 to 2.17, P=0.40).Conclusions Current evidence shows that single layer suture of uterine incision, induction of labor, induction with prostaglandins, induction with oxytocin and augmentation of labor with oxytocin are the risk factors of complete uterine rupture. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.

Citation： LIN Chunrong, LIU Guangyu, CAO Tiantian, LIU Xinghui. The risk factors of complete uterine rupture: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2020, 20(10): 1187-1192. doi: 10.7507/1672-2531.202006145 Copy

1.	谢幸, 孔北华, 段涛. 妇产科学. 北京: 人民卫生出版社, 2018.
2.	Liu Z, Yang H X, Xin H, et al. Current status of uterine rupture: a multi-center survey in China. Chin J Obstet Gynecol, 2019, 54(6): 363-368.
3.	伍绍文, 何电, 张为远. 完全性子宫破裂28例临床分析. 中国实用妇科与产科杂志, 2018, 34(10): 1134-1138.
4.	单可记, 王名芳, 许汪斌, 等. 妊娠期完全性子宫破裂105例临床分析. 实用妇产科杂志, 2019, 35(10): 769-773.
5.	Hidalgo-Lopezosa P, Hidalgo-Maestre M. Risk of uterine rupture in vaginal birth after cesarean: Systematic review. Enferm Clin, 2017, 27(1): 28-39.
6.	刘鸣, 吴红梅, 卫茂玲. 系统评价、Meta-分析设计与实施方法. 北京: 人民卫生出版社, 2011.
7.	Hochler H, Wainstock T, Lipschuetz M, et al. Grandmultiparity, maternal age, and the risk for uterine rupture-A multicenter cohort study. Acta Obstet Gynecol Scand, 2020, 99(2): 267-273.
8.	Cunningham S, Algeo CE, DeFranco EA. Influence of interpregnancy interval on uterine rupture. J Matern-Fetal Neo M, 2019, (1): 1-6.
9.	Salman L, Hiersch L, Shmueli A, et al. Complicated primary cesarean delivery increases the risk for uterine rupture at subsequent trial of labor after cesarean. Arch Gynecol Obstet, 2018, 298(2): 273-277.
10.	Thisted DLA, Mortensen LH, Hvidman L, et al. Operative technique at caesarean delivery and risk of complete uterine rupture in a subsequent trial of labour at term. A registry case-control study. Plos One, 2017, 12(11): 1-13.
11.	Sturzenegger K, Schäffer L, Zimmermann R, et al. Risk factors of uterine rupture with a special interest to uterine fundal pressure. J Perinat Med, 2017, 45(3): 309-313.
12.	Thisted DL, Mortensen LH, Krebs L. Uterine rupture without previous caesarean delivery: a population-based cohort study. Eur J Obstet Gynecol Reprod Biol, 2015, 195: 151-155.
13.	Ronel D, Wiznitzer A, Sergienko R, et al. Trends, risk factors and pregnancy outcome in women with uterine rupture. Arch Gynecol Obstet, 2012, 285(2): 317-321.
14.	Fitzpatrick K, Kurinczuk J, Alfirevic Z, et al. Uterine rupture by intended mode of delivery in the UK: a national case-control study. Plos Med, 2012, 9(3): e1001184.
15.	Harper LM, Cahill AG, Boslaugh S, et al. The association of uterine rupture and labor induction in vaginal birth after cesarean: A survival analysis. Reprod Sci, 2011, 206(51): e1-e5.
16.	Weimar CH, Lim AC, Bots ML, et al. Risk factors for uterine rupture during a vaginal birth after one previous caesarean section: a case-control study. Eur J Obstet Gynecol Reprod Biol, 2010, 151(1): 41-45.
17.	Le Ray C, Goffinet F. The role of uterine closure in the risk of uterine rupture. Obstet Gynecol, 2010, 116(4): 994-995.
18.	Sciscione AC, Landon MB, Leveno KJ, et al. Previous preterm cesarean delivery and risk of subsequent uterine rupture. Obstet Gynecol, 2008, 111(3): 648-653.
19.	Cahill AG, Waterman BM, Stamilio DM, et al. Higher maximum doses of oxytocin are associated with an unacceptably high risk for uterine rupture in patients attempting vaginal birth after cesarean delivery. Am J Obstet Gynecol, 2008, 199(32): e1-e5.
20.	Gyamfi C, Juhasz G, Gyamfi P, et al. Single- versus double-layer uterine incision closure and uterine rupture. J Matern Fetal Neonatal Med, 2006, 19(10): 639-643.
21.	Hammoud A, Hendler I, Gauthier RJ, et al. The effect of gestational age on trial of labor after Cesarean section. J Matern Fetal Neonatal Med, 2004, 15(3): 202-206.
22.	Shipp TD, Zelop C, Repke JT, et al. The association of maternal age and symptomatic uterine rupture during a trial of labor after prior cesarean delivery. Obstet Gynecol, 2002, 99(4): 585-588.
23.	Zelop CM, Shipp TD, Repke JT, et al. Uterine rupture during induced or augmented labor in gravid women with one prior cesarean delivery. Am J Obstet Gynecol, 1999, 181(4): 882-886.
24.	Dekker GA, Chan A, Luke CG, et al. Risk of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: a retrospective population-based cohort study. BJOG, 2010, 117(11): 1358-1365.
25.	Al-Zirqi I, Stray-Pedersen B, Forsén L, et al. Uterine rupture: trends over 40 years. BJOG, 2016, 123(5): 780-787.

1. 谢幸, 孔北华, 段涛. 妇产科学. 北京: 人民卫生出版社, 2018.
2. Liu Z, Yang H X, Xin H, et al. Current status of uterine rupture: a multi-center survey in China. Chin J Obstet Gynecol, 2019, 54(6): 363-368.
3. 伍绍文, 何电, 张为远. 完全性子宫破裂28例临床分析. 中国实用妇科与产科杂志, 2018, 34(10): 1134-1138.
4. 单可记, 王名芳, 许汪斌, 等. 妊娠期完全性子宫破裂105例临床分析. 实用妇产科杂志, 2019, 35(10): 769-773.
5. Hidalgo-Lopezosa P, Hidalgo-Maestre M. Risk of uterine rupture in vaginal birth after cesarean: Systematic review. Enferm Clin, 2017, 27(1): 28-39.
6. 刘鸣, 吴红梅, 卫茂玲. 系统评价、Meta-分析设计与实施方法. 北京: 人民卫生出版社, 2011.
7. Hochler H, Wainstock T, Lipschuetz M, et al. Grandmultiparity, maternal age, and the risk for uterine rupture-A multicenter cohort study. Acta Obstet Gynecol Scand, 2020, 99(2): 267-273.
8. Cunningham S, Algeo CE, DeFranco EA. Influence of interpregnancy interval on uterine rupture. J Matern-Fetal Neo M, 2019, (1): 1-6.
9. Salman L, Hiersch L, Shmueli A, et al. Complicated primary cesarean delivery increases the risk for uterine rupture at subsequent trial of labor after cesarean. Arch Gynecol Obstet, 2018, 298(2): 273-277.
10. Thisted DLA, Mortensen LH, Hvidman L, et al. Operative technique at caesarean delivery and risk of complete uterine rupture in a subsequent trial of labour at term. A registry case-control study. Plos One, 2017, 12(11): 1-13.
11. Sturzenegger K, Schäffer L, Zimmermann R, et al. Risk factors of uterine rupture with a special interest to uterine fundal pressure. J Perinat Med, 2017, 45(3): 309-313.
12. Thisted DL, Mortensen LH, Krebs L. Uterine rupture without previous caesarean delivery: a population-based cohort study. Eur J Obstet Gynecol Reprod Biol, 2015, 195: 151-155.
13. Ronel D, Wiznitzer A, Sergienko R, et al. Trends, risk factors and pregnancy outcome in women with uterine rupture. Arch Gynecol Obstet, 2012, 285(2): 317-321.
14. Fitzpatrick K, Kurinczuk J, Alfirevic Z, et al. Uterine rupture by intended mode of delivery in the UK: a national case-control study. Plos Med, 2012, 9(3): e1001184.
15. Harper LM, Cahill AG, Boslaugh S, et al. The association of uterine rupture and labor induction in vaginal birth after cesarean: A survival analysis. Reprod Sci, 2011, 206(51): e1-e5.
16. Weimar CH, Lim AC, Bots ML, et al. Risk factors for uterine rupture during a vaginal birth after one previous caesarean section: a case-control study. Eur J Obstet Gynecol Reprod Biol, 2010, 151(1): 41-45.
17. Le Ray C, Goffinet F. The role of uterine closure in the risk of uterine rupture. Obstet Gynecol, 2010, 116(4): 994-995.
18. Sciscione AC, Landon MB, Leveno KJ, et al. Previous preterm cesarean delivery and risk of subsequent uterine rupture. Obstet Gynecol, 2008, 111(3): 648-653.
19. Cahill AG, Waterman BM, Stamilio DM, et al. Higher maximum doses of oxytocin are associated with an unacceptably high risk for uterine rupture in patients attempting vaginal birth after cesarean delivery. Am J Obstet Gynecol, 2008, 199(32): e1-e5.
20. Gyamfi C, Juhasz G, Gyamfi P, et al. Single- versus double-layer uterine incision closure and uterine rupture. J Matern Fetal Neonatal Med, 2006, 19(10): 639-643.
21. Hammoud A, Hendler I, Gauthier RJ, et al. The effect of gestational age on trial of labor after Cesarean section. J Matern Fetal Neonatal Med, 2004, 15(3): 202-206.
22. Shipp TD, Zelop C, Repke JT, et al. The association of maternal age and symptomatic uterine rupture during a trial of labor after prior cesarean delivery. Obstet Gynecol, 2002, 99(4): 585-588.
23. Zelop CM, Shipp TD, Repke JT, et al. Uterine rupture during induced or augmented labor in gravid women with one prior cesarean delivery. Am J Obstet Gynecol, 1999, 181(4): 882-886.
24. Dekker GA, Chan A, Luke CG, et al. Risk of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: a retrospective population-based cohort study. BJOG, 2010, 117(11): 1358-1365.
25. Al-Zirqi I, Stray-Pedersen B, Forsén L, et al. Uterine rupture: trends over 40 years. BJOG, 2016, 123(5): 780-787.

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