Clinical analysis of complete uterine rupture during pregnancy

Xie, Jing; Lu, Xuefang; Liu, Miao

doi:10.1186/s12884-024-06394-2

BMC Pregnancy and Childbirth

Table 2 Data of 33 cases of complete uterine rupture

From: Clinical analysis of complete uterine rupture during pregnancy

Serial number	Age (y)	Gestation week (w)	No. of pregnancies	CS-VVF(mm)	Risk factor	Time since previous CS (month)	Location and size of the breach	Bleeding volume (ml) and blood transfusions	Causes and clinical manifestations	Comorbidities and outcomes^b	Minimum hemoglobin (g/L)
1	27	33⁺³	2	25.8	CS1, mental retardation	13	Original CS scar, 10 cm	intraperitoneal 900, hemorrhage 100	Bloating 8 + h	stillbirth	98
2	35	29⁺¹	6	22.1	CS1, AA4	38	Multiple large ruptures of the uterus (original CS scar, lower back wall, left side wall)	intraperitoneal 1600, hemorrhage 500 erythrocyte 10 U	Coma total hysterectomy	Stillbirth, traffic accidents	50
3	31	38	7	27.5	VB4, CS2	36	Original CS scar right side, 5 cm	Intraperitoneal 3000, hemorrhage 3000 erythrocyte 14 U, plasma 600 ml	Vaginal hemorrhage after delivery 4 h subtotal hysterectomy	10′ 3500 g PI	57
4	32	36⁺¹	2	38.5	CS1 (Superimposed Preeclampsia)	75	Original CS scar, 2 cm	Intraperitoneal 1500, hemorrhage 200 erythrocyte 6 U, plasma 600 ml	Persistent abdominal pain after spontaneous delivery of a stillborn baby	stillbirth CHWSP	61
5	26	38⁺⁵	2	26.9	CS1	34	Original CS scar, 2 cm	intraperitoneal 100, hemorrhage 600	Painless vaginal bleeding 1 day	8’-10′ 3300 g CPP + PI	102
6	32	26⁺³	3	22.7	CS1 (twins, PPH), AA1, 2013 Laparoscopy for EMT	13	Original CS scar, 10 cm	intraperitoneal 2000, hemorrhage 2000 erythrocyte 14 U, plasma 1000 ml	Bloating 8 + h total hysterectomy	stillbirth	70
7	45	29⁺³	6	38.5	VB4, CS1, Double uterus (single cervix, double uterine cavity)	58	Right uterine corpus, 15 cm, (up to the uterine fundus and down to the endocervix)	intraperitoneal 2000, hemorrhage 200 erythrocyte 8 U, plasma 600 ml	abdominal pain 7 + h Removal of the body of the uterus on the sick side	stillbirth CH	69
8	30	29	3	-	VB1 (CPP, PPH), AA1, curettage 1 (retained placenta)	—	Uterine fundus, 10 cm	intraperitoneal 200, hemorrhage 3000 erythrocyte 8 U, plasma 400 ml	Persistent epigastric pain 1 + day total hysterectomy	9’-10′ 1400 g PI	43
9	27	33	5	38.9	CS1, AA3	37	Original CS scar, 2 cm	intraperitoneal 300, hemorrhage 4000 erythrocyte 14 U, plasma 1600 ml, cold precipitation 12 U	Heavy vaginal bleeding 2 + h total hysterectomy	10′ 1900 g CPP + PP	67
10	29	15	5	-	CS2, AA2	27	Original CS scar right side, 3 cm	intraperitoneal 3200, hemorrhage 400 erythrocyte 6 U, plasma 800 ml, cold precipitation 12 U	Persistent left lower abdominal pain 1 day, diarrhea 5 times, Vomit once	stillbirth CSP	55
11	32	40⁺²	3	18.4	CS1, AA1	61	Left posterior wall near endocervix, 3 cm, vertical	intraperitoneal 50, hemorrhage 200	—	10′ 3150 g	104
12	29	34⁺³	5	32.5	CS2, AA2	73	Original CS scar, 10 cm	intraperitoneal 1000, hemorrhage 200 plasma 1000 ml	Abdominal pain with vaginal drainage 10 h	stillbirth HELLP syndrome	65
13	33	29⁺⁴	5	-	VB2, AA2	—	Bottom of the uterus near the right uterine horn, 5 cm	intraperitoneal 1500, hemorrhage 200 erythrocyte 4 U	Persistent lower abdominal pain (slightly to the right around the umbilicus) 5 + h	6’-9’-9′ 1350 g PI, insufficient amniotic fluid	59
14	30	33	7	26.7	CS1 (superimposed preeclampsia), VBAC1, AA3, 2016 Laparoscopic right tubal opening for embryo retrieval	58(VB 28、IC 13)^a	Right uterine fundus, old, 4 cm, covered by large omental adhesions	hemorrhage 1000	Vaginal bleeding 10 + days	9’-10′ 1990 g CPP	101
15	34	26	6	25.0	VB2, CS1, AA2	46	Original CS scar right side, 1 cm	intraperitoneal 2000, hemorrhage 1000 autologous blood 750 ml, erythrocyte 4 U, plasma 600 ml, cold precipitation 6 U	Abdominal pain 3 h, ultrasound suggests abdominal fluid	5’-9’-10′ 1100 g PP、GDM	69
16	33	35⁺⁵	7	28.2	CS1 (right uterine horn wedge excision, PPH), AA5	62(IC 36)^a	Right uterine horn, 3 cm, covered by large omental adhesions	intraperitoneal 50, hemorrhage 300	Bloating 2 days	10′ 2650 g wind heart disease; GDM	117
17	30	40⁺³	4	-	VB2, AA1	—	Posterior wall of the uterus near the ligamentum intrinsicum of the left ovary, 6 cm, vertical	intraperitoneal 500, hemorrhage 1000 erythrocyte 8 U	Premature rupture of membranes after multiple intercourse, oxytocin, changes in fetal position and heart rate	2’-2’-3′ 3600 g	62
18	30	26⁺⁵	4	-	AA3	—	Left uterine fundus, 1 cm	intraperitoneal 2500, hemorrhage 3000 erythrocyte 12 U, cold precipitation 16 U	abdominal pain with vomiting 7 + h, LMWH	double stillbirth IVF-ET	52
19	31	21	4	-	VB1, AA2	—	Right posterior wall near the cervix, 3 cm	intraperitoneal 500, hemorrhage 1000 erythrocyte 6 U	Bloating 2 days	stillbirth	63
20	31	37	4	-	VB1, AA2	—	Right side of uterus near round ligament, 6 cm	intraperitoneal 1000, hemorrhage 600 erythrocyte 8 U, plasma 600 ml	Breech delivery, difficulty delivering the fetal head	3’-4’-4′ 3550 g	59
21	37	39⁺¹	3	38.8	CS1, VBAC1	42(VB 24)^a	Original CS scar, 2 cm	hemorrhage 200	intrauterine distress	10′ 3700 g	105
22	30	38	5	18.0	CS1, AA3, double uterus (single cervix, double uterine cavity)	30	Connection of the posterior walls of both uterine cavities, 1 cm	hemorrhage 1500 autologous blood 500 ml, erythrocyte 2 U	—	10′ 3450 g CPP, transverse fetal position	82
23	38	23⁺³	7	17.6	CS3 (eclampsia, severe adhesion), AA3	26	Original CS scar near cervix, 3 cm, severe adhesion	intraperitoneal 500, hemorrhage 200	After mifepristone and misoprostol, abdominal pain with vaginal bleeding 7 h, ultrasound shows uterine rupture	stillbirth CHWSP, GDM	97
24	37	32	9	-	VB2, AA5, 2015 Laparoscopic Left Tubectomy	—	Uterine fundus, 12 cm	intraperitoneal 2500, hemorrhage 1500 erythrocyte 8 U, cold precipitation 6 U	Abdominal pain 8 h,vomit once, coma 30 min	stillbirth	76
25	23	34⁺¹	5	31.6	VB3, CS1	15	Original CS scar, T-shape, 5 × 3 cm, metal ring	intraperitoneal 500, hemorrhage 500	Lower abdominal pain with vaginal bleeding 1 day, uterine area tenderness	stillbirth	100
26	40	38⁺⁶	3	18.6	CS1, AA1 (CSP)	156	Left side of original CS scar, 2 cm	intraperitoneal 50, hemorrhage 400	Bloating 2 days	10′ 2850 g adenomyosis, IVF-ET	91
27	32	38⁺²	5	20.5	CS1 (PI), AA3, 2019 transabdominal cerclage	13	Lower part of the posterior uterine wall, 2 cm, left broad ligament, 2 cm	hemorrhage 400	—	10′ 3950 g PA	116
28	33	³¹⁺¹	4	21.7	CS1, AA2	84	Original CS scar, 1 cm	intraperitoneal 500, hemorrhage 200	Ethacridine, uterine area tenderness, ultrasound shows uterine rupture	stillbirth	92
29	36	29	5	19.8	CS2 (PPH), AA2	58	Original CS scar, T-shape, 4 × 5 cm	hemorrhage 800 erythrocyte 6 U	Ethacridine, uterine area tenderness, ultrasound shows uterine rupture	stillbirth	71
30	21	39	4	26.5	CS3, HIV	14	Middle part of anterior wall of uterus, 4 cm	hemorrhage 400	—	10′ 2900 g MPP	80
31	39	37⁺²	4	-	VB2, AA1, 2018UM	—	Lower part of the anterior wall of the uterus near the left broad ligament, 3 cm	intraperitoneal 50, hemorrhage 600	—	10′ 3500 g PPP + P, GDM	93
32	37	21	4	-	CS1, AA2	51	Anterior wall near the left uterine horn to the endocervical os, 10 cm	intraperitoneal 1200, hemorrhage 200 erythrocyte 4 U, cold precipitation 14 U	Spontaneous labor after stillbirth, uterine area tenderness, ultrasound shows uterine rupture	stillbirth CPP	78
33	33	32⁺¹	3	19.9	CS2	53	Lower part of the posterior uterine wall, 1 cm	intraperitoneal 3000, hemorrhage 1000 erythrocyte 30 U, plasma 5800 ml, cold precipitation 88 U, platelet 36 U	Tachycardia, bloating, shock litogun, LMWH, total hysterectomy	stillbirth, maternal death, PPP + PP, PGDM	51

Caesarean Section CS, Vaginal Birth VB, Artificial Abortion AA, Ectopic Pregnancy EP, Caesarean Scar Pregnancy CSP, Postpartum Hemorrhage PPH, Complete Placenta Previa CPP, Marginal Placenta Previa MPP, Pernicious Placenta Previa PPP, Placenta Accreta PA, Placenta Increta PI, Placenta Percreta PP, Low Molecular Weight Heparin LMWH, Hypertensive Disorders of Pregnancy HDP, Chronic Hypertension with Superimposed Preeclampsia CHWSP, Chronic Hypertension CH, Pregestational Diabetes Mellitus PGDM, Gestational Diabetes Mellitus GDM, In Vitro Fertilization and Embryo Transfer IVF-ET, Endometriosis EMT, Uterine Myomectomy UM, Vaginal Birth after Cesarean VBAC, Trial Of Labor After Cesarean TOLAC, Induce Childbirth IC, Periconceptional Caesarean Section Scar to Vesicovaginal Fold Distance CS-VVF
^aCase 14: This pregnancy occurred 28 months after vaginal delivery by cesarean section, followed by a induced labor with an interval of 23 months from pregnancy. Case 16: pregnancy was induced 36 months after cesarean section. Case 21: the pregnancy was 24 months after a vaginal delivery following a cesarean section
^bFetal outcomes including: Apgar scores and weights of stillbirths and live births

Back to article page

ISSN: 1471-2393

Contact us

Submission enquiries: bmcpregnancyandchildbirth@biomedcentral.com
General enquiries: ORSupport@springernature.com