Abstract
Objective: To study the outcomes of new pregnancies after previous
complete uterine rupture. Design: Descriptive study based on population
data from the Medical Birth Registry of Norway, the Patient
Administration System, and medical records. Sample: Maternities with
previous complete uterine rupture in Norway during the period 1967–2011
(N=72), extracted from 2 455 797 maternities. Method: We measured the
rate of new complete ruptures and partial ruptures, as well as the
maternal and perinatal outcomes of these pregnancies. The
characteristics of both previous ruptures and new ruptures were
described. Results: Among 72 maternities, there were thirty-seven with
previous ruptures in the lower segment (LS) and 35 outside the LS. We
found three new complete ruptures and six uneventful partial ruptures,
resulting in a rate of 4.2% and 8.3%, respectively. All three complete
ruptures occurred preterm in scars outside the LS. The rate of new
complete rupture was 0% in those with previous rupture in the LS, and
8.6% in previous ruptures outside the LS. The corrected perinatal
mortality was 1.3%, and prematurity (<37 weeks) was high
(36.1%); this was noticed even in the absence of new ruptures and was
mostly iatrogenic. Two hysterectomies were performed in the absence of
rupture and two cases had abnormal invasive placenta. Conclusion: The
prognosis for pregnancies after previous complete uterine rupture is
favorable. Prematurity is a problem caused by both obstetrician and
mother anxiety, so the timing of delivery is most challenging. Careful
counseling, vigilance for symptoms, and immediate delivery are most
important.