JHSM

Journal of Health Sciences and Medicine (JHSM) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

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Original Article
Comparative analysis of second- and third-trimester complete uterine rupture cases followed up in a tertiary hospital: a retrospective cohort study
Aims: There are not many studies that compared the uterine rupture cases pertaining to different trimesters of pregnancy in terms of the changes in relevant risk factors and fetomaternal outcomes. In this context, this study was carried out to comparatively analyze the cases who were diagnosed with complete uterine rupture and gave birth in the hospital where this study was conducted in terms of the relevant risk factors and fetomaternal outcomes. Material and
Methods: The population of this retrospective study consisted of patients who were diagnosed with complete uterine rupture and gave birth in our hospital between January 2015 and June 2022. Patients’ demographic characteristics, cesarean section, labor induction histories, and fetal and maternal outcomes were recorded. The patients included in this study were divided into two groups based on the trimester when the complete uterine rupture occurred as second- and third-trimester complete uterine rupture groups. The groups were compared in terms of fetal, maternal, and obstetric outcomes.
Results: Out of the 56718 deliveries performed during the study period, a total of 27 complete uterine rupture cases, of whom 10 had second-, and 17 had third-trimester uterine rupture, were included in the study sample. Accordingly, the incidence of rupture was calculated as 0.047%. Of these 27 cases, 9 had re-pregnancy. Bilateral hypogastric artery ligation was performed in seven patients and six of these patients were in the third trimester rupture group. Of the 27 cases with complete uterine rupture, 19 had a cesarean section history. All 8 cases that did not have a cesarean section history had a complete uterine rupture in the third trimester.
Conclusion: Complete uterine rupture is associated with adverse maternal and fetal outcomes. Fertility-sparing surgery (primary repair) is the first-line therapy. The prognosis of second-trimester uterine ruptures is more unfavorable compared to third-trimester uterine ruptures from the fetal point of view yet more favorable from the maternal point of view.


1. Gibbins KJ, Weber T, Holmgren CM, Porter TF, Varner MW,Manuck TA. Maternal and fetal morbidity associated with uterinerupture of the unscarred uterus. Am J Obstet Gynecol 2015; 213:382.e1-6.
2. Kaczmarczyk M, Sparén P, Terry P, Cnattingius S. Risk factorsfor uterine rupture and neonatal consequences of uterine rupture:a population-based study of successive pregnancies in Sweden.BJOG Int J Obstet Gynaecol 2007; 114: 1208-14.
3. Ofir K, Sheiner E, Levy A, Katz M, Mazor M. Uterine rupture:risk factors and pregnancy outcome. Am J Obstet Gynecol 2003;189: 1042-6.
4. Al Qahtani NH, Al Hajeri F. Pregnancy outcome and fertilityafter complete uterine rupture: a report of 20 pregnancies and areview of literature. Arch Gynecol Obstet 2011; 284: 1123-6.
5. Lim AC, Kwee A, Bruinse HW. Pregnancy after uterine rupture:a report of 5 cases and a review of the literature. Obstet GynecolSurv 2005; 60: 613-7.
6. Ritchie EH. Pregnancy after rupture of the pregnant uterus. Areport of 36 pregnancies and a study of cases reported since 1932.J Obstet Gynaecol Br Commonw 1971; 78: 642-8.
7. Herrera FA, Hassanein AH, Bansal V. Atraumatic spontaneousrupture of the non-gravid uterus. J Emerg Trauma Shock 2011;4: 439.
8. Bulletins-Obstetrics Committee. ACOG practice bulletin no.205: vaginal birth after cesarean delivery. Obstet Gynecol 2019;133: e110-27.
9. Zwart JJ, Richters JM, Ory F, de Vries JIP, BloemenkampKWM, van Roosmalen J. Uterine rupture in The Netherlands:a nationwide population-based cohort study. BJOG Int J ObstetGynaecol 2009; 116: 1069-78; discussion 1078-1080.
10. Daponte A, Nzewenga G, Dimopoulos KD, Guidozzi F. The use ofvaginal misoprostol for second-trimester pregnancy terminationin women with previous single cesarean section. Contraception2006; 74: 324-7.
11. Dickinson JE. Misoprostol for second-trimester pregnancytermination in women with a prior cesarean delivery. ObstetGynecol 2005105: 352-6.
12. Morris JL, Winikoff B, Dabash R, et al. FIGO’s updatedrecommendations for misoprostol used alone in gynecology andobstetrics. Int J Gynaecol Obstet Off Organ Int Fed GynaecolObstet 2017; 138: 363-6.
13. Grobman W, Lai Y, London M, et al. Prediction of uterine ruptureassociated with attempted vaginal birth after cesarean delivery.Am J Obstet Gynecol 2008; 199: 30.
14. Dekker GA, Chan A, Luke CG, et al. Risk of uterine rupturein Australian women attempting vaginal birth after one priorcaesarean section: a retrospective population-based cohort study.BJOG Int J Obstet Gynaecol 2010; 117: 1358-65.
15. Leung AS, Leung EK, Paul RH. Uterine rupture after previouscesarean delivery: maternal and fetal consequences. Am J ObstetGynecol 1993; 169: 945-50.
16. Guiliano M, Closset E, Therby D, LeGoueff F, Deruelle P, SubtilD. Signs, symptoms and complications of complete and partialuterine ruptures during pregnancy and delivery. Eur J ObstetGynecol Reprod Biol 2014; 179: 130-4.
17. American College of Obstetricians and Gynecologists. Vaginalbirth after previous cesarean delivery. ACOG Pract Patterns Bull1995; 1: 1-8.
18. Chen LH, Tan KH, Yeo GS. A ten-year review of uterine rupturein modern obstetric practice. Ann Acad Med Singapore 1995; 24:830-5.
19. Usta IM, Hamdi MA, Musa AAA, Nassar AH. Pregnancyoutcome in patients with previous uterine rupture. Acta ObstetGynecol Scand 2007; 86: 172-6.
Volume 6, Issue 2, 2023
Page : 428-432
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