Operated uterus syndrome: what is next?

• Anton S. Olenev
• Yulia D. Vuchenovich
• Vladislavа A. Novikovа
• Victor E. Radzinsky

Abstract

The aim of the study - to assess the significance of the operated uterus in near miss risks when it ruptures.

Material and methods. A retrospective multicenter cohort study was conducted in 27 healthcare institutions of the megalopolis of Russia with 1 January 2013 to 31 December 2018.

Results. The relative risk (RR) of near miss in the operated uterus was insignificant in comparison with potentially life-threatening conditions (PLTC) [RR=0.95 (95% CI 0.34-2.65)]. When the uterus with scar ruptured the relative risk of near miss compared to PLTC was not significant [RR=0.78 (95% CI 0.24-2.51)]. An inverse correlation has been established between the thickness of the lower uterine segment in the scar area and the volume of blood loss (r=-0.58, p<0.05). The uterus scar determines the following characteristics of patients with near miss - higher rates (p<0.05) of the number of pregnancies, childbirth, gestational age at the first appearance in the antenatal clinic, duration of the first period of labor or cesarean, blood loss, lower rates (p<0.05) of the gestational period during delivery, weight of the newborn and scoring his condition in Apgar on the 1^st and 5^th minutes.

Conclusion. Absence of a uterine scar after operations carried out on it does not preclude changes in the structure of the myometrium, predisposing to rupture with inadequate load pressure (pregnancy, childbirth). A scar on the uterus is not a prerequisite for the development of near miss with its rupture. However, near miss uterine scar is associated with an increase in the frequency of uterine rupture during pregnancy, a complete rupture of the uterus, the need for ligation of the branches of the ascending uterine artery and/or internal iliac arteries, and antenatal fetal death. The likelihood of severe complications for the mother and newborn with uterine rupture leaves an inexhaustible resource for finding preventive measures for diseases or interventions that increase the risk of myometrial rupture during pregnancy, childbirth and the postpartum period, the development of potentially critical obstetric conditions or near miss.

Keywords:operated uterus, uterus scar, uterine rupture, cesarean section, near miss, potentially life threatening condition, critical obstetric conditions

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