Clinical characteristics and outcomes of preterm versus term uterine
rupture: a nationwide observational study
Abstract
Objective: To assess and compare the clinical aspects of
uterine rupture by dividing the gestational age at uterine rupture
occurrence into <37-week (preterm) and ≥37-week (term) groups.
Design: Retrospective cohort study. Setting: 187
acute-care hospitals in Japan. Population: Pregnant women
diagnosed with uterine rupture. Methods: We conducted a large
nationwide study using a national inpatient database from July 2010 to
March 2022. The patients’ characteristics, in-hospital procedures, and
outcomes were investigated and compared between those who developed
uterine rupture at preterm and term groups. Main Outcome
Measures: Hysterectomy, complications, proportion of blood
transfusions, and postoperative length of stay. Results: In
total, 298 eligible patients were identified (161 in preterm group and
137 in term group). The incidence of placenta accreta spectrum was
significantly higher in the preterm than term group (18.0% vs. 6.6%,
respectively; P = 0.003). Vacuum delivery (19.0% vs. 0.6%, P
< 0.001) and uterine fundal pressure (2.9% vs. 0.0%, P =
0.004) were more likely to be applied in the term than preterm group.
The maternal need for mechanical ventilation (26.3% vs. 12.4%, P =
0.003), the incidence of disseminated intravascular coagulation (40.1%
vs. 25.5%, P = 0.009), and the requirement for platelet transfusions
(32.8% vs. 15.5%, P < 0.001) were greater in the term than
preterm group. Additionally, the duration of the postoperative hospital
stay was longer in the term group. Conclusions: This study
shows that individual characteristics vary with the gestational age at
uterine rupture and that the maternal morbidity rate is notably higher
in term than preterm uterine ruptures.