Uterine Rupture Mortality Rate - Mothering Forums
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#1 of 14 Old 01-08-2009, 01:58 AM - Thread Starter
 
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So the uterine rupture rate for VBACs is less than 1%, right? But what's the mortality rate of uterine rupture? Where would I find this statistic?

Thanks,
Lydia
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#2 of 14 Old 01-08-2009, 02:01 AM
 
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http://lib.bioinfo.pl/meid:85714

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RESULTS: Over the 10 years, there were 114,933 deliveries with 39 cases of uterine rupture: 18 complete and 21 incomplete (dehiscence). Thirty-six women had a previous cesarean delivery: 33 low transverse, two classic, one low vertical. Of the 114,933 deliveries, 11,585 (10%) were in women with a previous cesarean delivery. Uterine rupture in those undergoing a trial for vaginal delivery (4516) was complete rupture in 2.4 per 1000 and dehiscence in 2.4 per 1000. There were no maternal deaths, and maternal morbidity was low in patients with dehiscence. In comparison, 44% of those with complete uterine rupture received blood transfusion (odds ratio 7.60, 95% confidence interval 1.14, 82.14, P =.025). Two perinatal deaths were attributable to complete uterine rupture, one after previous cesarean delivery. Compared with dehiscence, infants born after uterine rupture had significantly lower 5-minute Apgar scores (P <.001) and asphyxia, needing ventilation for more than 1 minute (P <.01). CONCLUSION: In 92% of cases, uterine rupture was associated with previous cesarean delivery. Uterine dehiscence was associated with minimal maternal and perinatal morbidity. In contrast, complete uterine rupture was associated with significantly more maternal blood transfusion and neonatal asphyxia.
So out of 39 ruptures there were 2 perinatal deaths. (5%)

http://www.ncbi.nlm.nih.gov/pubmed/14520209

Quote:
RESULTS: Seventy-two of the 361 articles (20%) that were identified met the inclusion criteria. A 6.2 per 1000 trial of labor rate of uterine rupture (total=880 uterine ruptures in 142,075 trials of labor) was determined. For every 1000 trials of labor the uterine rupture-related complication rate was 1.8 for packed red blood cell transfusion, 1.5 for pathologic fetal acidosis (cord pH<7.00), 0.9 for hysterectomy, 0.8 for genitourinary injury, 0.4 for perinatal death, and 0.02 for maternal death. The perinatal mortality rate was significantly lower among studies from the United States versus other countries (0.3 vs 0.6; odds ratio, 0.50; 95% CI, 0.26-0.94) and in series that exceeded 1000 patients (0.2 vs 1.7; odds ratio, 7.34; 95% CI, 3.94-13.69). CONCLUSION: Although relatively uncommon, uterine rupture is associated with several adverse outcomes, depending on the time of the publication and the site and size of the population that was studied.
So for 880 ruptures, 213 fetal acidosis (24%), 56 perinatal deaths (6%), 2 maternal deaths (0.2%)
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#3 of 14 Old 01-08-2009, 02:01 AM
 
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subbing as i would like to know this too. also i would like to know what is the result of uterine rupture?-can you have more kids after one?
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#4 of 14 Old 01-08-2009, 02:18 AM
 
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Originally Posted by mommabear207 View Post
subbing as i would like to know this too. also i would like to know what is the result of uterine rupture?-can you have more kids after one?
Depends on if your doctor is willing to attempt a uterine repair, what type of repair they are able to do, and whether your uterus recovers and is not too scared to allow another pregnancy. Yes it is possible. But a lot of the data shows that doing a uterine repair is riskier than doing a hysterectomy so I don't know how many doctors would be willing to attempt the repair. If you are going to attempt VBAC and in the event of a rupture you are going to want a repair, it is probably good to make sure that your doctor knows this.
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#5 of 14 Old 01-08-2009, 10:01 AM
 
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I would think that the extent of the rupture and how soon a mamma got into surgery, would also effect whether or not she could safely keep her uterus. A more severe/extensive rupture would make repair less possible than a more 'minor' one.
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#6 of 14 Old 01-08-2009, 10:25 AM
 
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in 05 WHO put together a report/review on uterine rupture and maternal mortality/morbidity - maternal survival also has to do with what services are available at the time of rupture.
I know of a few uterine ruptures one in a Vbac mom who had a dehisence her and the baby were fine and the dehisence wasn't dx until 24 hrs after birth. another rupture was a friend of a friend the mom was a primip and she had a rupture in pregnancy- she went back and forth to emergency I am not remembering the story well- other than they blew it at emergency and sent her home- she survived but just barely I think that at small rural hospital she may have died she was in the ICU for weeks.

another issue on keeping a uterus would be is it complex like rupture with placenta accreta or something like that so there wouldn't be a simple repair that could be made also from what a friend of mine who was a primary assistant during surgery has told me can you stitch it all up and the bleeding stops or is there some hidden bleeding area? with blood all over it is really hard to decern--
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#7 of 14 Old 01-08-2009, 09:03 PM
 
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complete uterine rupture was associated with significantly more maternal blood transfusion and neonatal asphyxia.

The standard blood bank order for VBAC patients is "screen and hold", which means the blood bank takes a blood sample and makes sure there are no antibodies that would complicate a transfusion.

In case of a uterine rupture, the blood bank can quickly (within a few minutes) provide type-specific blood. And it can take large quantities of blood to keep the woman alive until the surgeon can stop the bleeding ... . 10-20 units is common for a medium-sized rupture, and I've heard of cases where it took 30-40 units plus a lot of clotting factors and plasma before things stabilized. (lab techs gossip a lot about their work)

Leaving the hospital alive, with a live baby, is the goal. Leaving the hospital with a usable uterus is a bonus.

If you are doing VBAC outside a hospital, the maternal survival rate for ruptures would be strikingly lower, because the uterus has a lot of blood vessels and when it rutures they are also ruptured ... death from hypovolemic shock can happen in a few minutes. The 44% who needed transfusions would be at high risk of hypovolemic shock before they could be transported. I doubt the baby would survive.


***********************
CONCLUSION: Our data confirm the relatively small risk of uterine rupture during vaginal birth after cesarean that has been demonstrated in previous studies. In an institution that has in-house obstetric, anesthesia, and surgical staff in which close monitoring of fetal and maternal well-being is available, uterine rupture does not result in major maternal morbidity and mortality or in neonatal mortality.

http://www.ncbi.nlm.nih.gov/pubmed/1...gdbfrom=pubmed
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#8 of 14 Old 01-08-2009, 10:59 PM
 
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This is what I'm seeing. If perinatal death is 5% and rupture rate is 1% then risk of perinatal death with a vbac is:

1 in 2000

and if rupture rate is .5% (as I've seen it quoted other places) and perinatal death is 5% then perinatal death risk for a vbac is:

.5 in 2000

Obviously the risk is higher with other incision types and lower with low horizontal double stitch.

Does anyone have surgical death risk numbers for repeat c/s? As well as other risk factors for surgery? This will be a good handout for my clients. :-)
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#9 of 14 Old 01-08-2009, 11:54 PM
 
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http://www.ncbi.nlm.nih.gov/pubmed/11084565
Quote:
Uterine rupture occurred more frequently among women undergoing a trial of labor than among those undergoing elective repeat cesarean delivery (odds ratio, 2.10; 95% confidence interval, 1.45-3.05). There was no difference in maternal mortality risk between the 2 groups (odds ratio, 1.52; 95% confidence interval, 0.36-6.38). Fetal or neonatal death (odds ratio, 1.71; 95% confidence interval, 1.28-2.28) and 5-minute Apgar scores <7 (odds ratio, 2.24; 95% confidence interval, 1.29-3.88) were more frequent in the trial of labor group than in the control group. Mothers undergoing a trial of labor were less likely to have febrile morbidity (odds ratio, 0.70; 95% confidence interval, 0.64-0.77) or to require transfusion (odds ratio, 0.57; 95% confidence interval, 0.42-0.76) or hysterectomy (odds ratio, 0.39; 95% confidence interval, 0.27-0.57). CONCLUSION: A trial of labor may result in small increases in the uterine rupture rate and in fetal and neonatal mortality rates with respect to elective repeat cesarean delivery. Maternal morbidity, including febrile morbidity, and the need for transfusion or hysterectomy may be reduced with a trial of labor.
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#10 of 14 Old 01-08-2009, 11:58 PM
 
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http://pediatrics.aappublications.or...ract/100/3/348
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Results. Infants delivered by ERCS had an increased rate of transient tachypnea compared with infants born by TOL (6% vs 3%). Compared with routine vaginal deliveries, the adjusted odds ratio of developing any respiratory problem after an ERCS was 2.3 (95% confidence interval [CI]: 1.4, 3.8), and for developing transient tachypnea was 2.6 (CI: 1.5, 4.5). In addition, two infants delivered by ERCS developed respiratory distress syndrome. Infants delivered after a TOL had increased rates of suspected and proven sepsis (5% vs 2% and 1% vs 0.1%, respectively).

Compared with a successful TOL, the infants delivered by cesarean section after a failed TOL had more neonatal morbidity and had a longer hospital stay (4.8 ± 2 vs 3.1 ± 2 days). The odds ratio for developing any respiratory illness after a failed TOL was 2.1 (95% CI: 1.1, 4.1), for suspected sepsis was 4.8 (95% CI: 2.6, 9.0), and for proven sepsis was 19.3 (95% CI: 2.0, 187). Neonatal outcomes after a successful TOL were similar to routine vaginal births.

Conclusion. Infants born by ERCS are at increased risk for developing respiratory problems compared with those born by TOL. However, TOL is associated with increased rates of suspected and proven sepsis. This appears to be limited to infants delivered by cesarean section after a failed TOL.
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#11 of 14 Old 01-09-2009, 12:00 AM
 
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http://www.ncbi.nlm.nih.gov/pubmed/12475574

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OBJECTIVES: To determine the incidence of maternal morbidity following elective caesarean section in women with a history of at least two previous caesarean sections, and to determine if the incidence of morbidity correlates with the number of previous sections. STUDY DESIGN: We conducted an individual chart review of all women who had an elective caesarean section because of a history of two previous sections from 1990 to 1999. RESULTS: There were 67,097 deliveries of babies weighing 500 g or more. The total number of cases eligible for the study was 250. There were 12 cases (4.8%) of placenta praevia of which four required a transfusion and two a hysterectomy. The incidence of wound infection was 6.3% and urinary tract infection was 11.2%. There were no cases of thromboembolism recorded. CONCLUSIONS: Maternal morbidity with elective repeat caesarean section is low. The major morbidity is associated with placenta praevia. We found no correlation between the incidence of maternal morbidity and the number of previous sections.
Out of 250 elective repeat c-sections 2 resulted in hysterectomy. <1%
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#12 of 14 Old 01-11-2009, 03:13 PM
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Maternal and neonatal outcomes after uterine rupture in labor.Yap OW, Kim ES, Laros RK Jr.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA.

OBJECTIVE: There is significant controversy about the risks related to attempted vaginal birth after cesarean and the implications for informed consent of the patient. Recent data suggest that women who deliver in hospitals with high attempted vaginal birth after cesarean rates are more likely to experience successful vaginal birth after cesarean, as well as uterine ruptures. We conducted a study to evaluate maternal and neonatal morbidity and mortality after uterine rupture at a tertiary care center. STUDY DESIGN: We performed a retrospective chart review of cases of uterine rupture from 1976 to 1998. All women who had a history of uterine rupture were identified with International Classification of Diseases, Ninth Revision, identifiers with hospital discharge data cross-referenced with a separate obstetric database. We abstracted demographic information, fetal heart rate patterns, maternal pain and bleeding patterns, umbilical cord gas values, and Apgar scores from the medical record. Outcome variables were uterine rupture events and major and minor maternal and neonatal complications. RESULTS: During the study period there were 38,027 deliveries. The attempted vaginal birth after cesarean rate was 61.3%, of which 65.3% were successful. We identified 21 cases of uterine rupture or scar dehiscence. Seventeen women had prior cesarean deliveries (10 with primary low transverse cesarean delivery, 3 with unknown scars, 1 with classic cesarean delivery, 2 with two prior cesarean deliveries, and 1 with four prior cesarean deliveries). Of the 4 women who had no history of previous uterine surgery, one had a bicornuate uterus whereas the others had no factors increasing the risk for uterine rupture. We confirmed uterine rupture and scar dehiscence in 19 women. Specific details were not available for 2 patients. Uterine rupture or scar dehiscence was clinically suspected in 16 women with 3 cases identified at delivery or after delivery. Sixteen women had symptoms of increased abdominal pain, vaginal bleeding, or altered hemodynamic status. There were 2 patients who required hysterectomies and 3 women who received blood transfusions; there were no maternal deaths related to uterine rupture. The fetal heart rate pattern in 13 cases showed bradycardia and repetitive variable or late decelerations. Thirteen neonates had umbilical artery pH >7.0. Two cases of fetal or neonatal death occurred, one in a 23-week-old fetus whose mother had presented to an outlying hospital and the second in a 25-week-old fetus with Potter's syndrome. All live-born infants were without evidence of neurologic abnormalities at the time of discharge. CONCLUSION: Our data confirm the relatively small risk of uterine rupture during vaginal birth after cesarean that has been demonstrated in previous studies. In an institution that has in-house obstetric, anesthesia, and surgical staff in which close monitoring of fetal and maternal well-being is available, uterine rupture does not result in major maternal morbidity and mortality or in neonatal mortality.

PMID: 11408884 [PubMed - indexed for MEDLINE]
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#13 of 14 Old 01-13-2009, 02:57 AM - Thread Starter
 
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Thank You. I'm definitely bookmarking this.
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#14 of 14 Old 01-13-2009, 03:10 AM
 
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Outstanding.

"The great enemy of the truth is very often not the lie, deliberate, contrived and dishonest, but the myth, persistent, persuasive and unrealistic."
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