Uterine Rupture and Dehiscence: Ten-Year Review and Case-Control Study

Sumac D. Diaz, MD, Jacob E. Jones, MD, MpH, Michael Seryakov, MD, William J. Mann, MD

Disclosures

South Med J. 2002;95(4) 

In This Article

Abstract and Introduction

Background. Previous cesarean section, oxytocin administration, and fetal macrosomia increase the risk of uterine rupture or dehiscence (URD).
Methods. All 25,718 deliveries at Riverside Regional Medical Center from January 1990 to June 2000 were reviewed to describe complications and identify risk factors for URD.
Results. Eleven uterine ruptures and 10 dehiscences occurred during this period (0.08%). One maternal death (5%) and three neonatal deaths (14%) occurred. Other complications included intrapartum nonreassuring fetal status (67%), 5-minute Apgar score <7 (52%), maternal blood transfusion (24%), neonatal hypoxic injury (14%), hysterectomy (14%), and endometritis (10%). Uterine rupture/dehiscence was independently associated with fetal weight ≥4,000 g, nonreassuring fetal status, use of oxytocin, and previous cesarean delivery; internal fetal monitoring reduced the risk of URD.
Conclusions. To reduce the risk of URD, a delivery plan should include assessment of cesarean history and fetal macrosomia, judicious use of oxytocin, and intrapartum monitoring for nonreassuring fetal status.

Uterine rupture is an uncommon obstetric complication with potentially devastating outcome for both mother and baby. Medical terminology used to describe uterine injury during delivery is imprecise, with the overlapping terms "window," "dehiscence," and "rupture" often used to describe various clinical manifestations. Rupture and dehiscence describe complete separation of the uterine wall (endometrium, myometrium, and serosa).[1] Rupture is often traumatic and may occur in an intact uterus or involve the majority of a uterine scar from previous cesarean delivery.[2] Dehiscence is a separation that involves only a portion of the uterine scar.[2]

"Windows," believed to arise from lack of complete healing of the original scar,[3] are a partial rather than a complete separation of uterine wall layers. Operative reports often describe windows as membranes so thin they can be seen through.

Uterine rupture complicates 0.05% of all pregnancies,[3] a reported incidence with no appreciable change since 1930.[4] The etiology of uterine rupture has been affected by the changing trends of obstetric practice. Today, the most common cause of rupture is separation of a previous cesarean scar.[2,5] Whereas scar dehiscence has an incidence of 0.6%, the risk of rupture increases minimally to 0.8% after previous lower segment cesarean section and greatly (>5%) after classical cesarean section.[3] Other predisposing factors include previous uterine trauma, congenital anomaly, abnormal placentation, and inappropriate oxytocin administration.[2]

The aim of this study was to review all cases of URD seen at Riverside Regional Medical Center (RRMC) during a 10-year period. Comparison of these case-patients and a control group allows both the identification of risk factors and development of methods for prevention of URD.

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