Uterine rupture and risk of near miss

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

Abstract

Uterine rupture is a severe maternal complication, classified as a potentially Life-threatening condition. The purpose of this study is to assess the risk of near miss in case of rupture of the uterus in the inhabitants of the metropolis.

Material and methods. A retrospective multicenter cohort study was conducted. Included 154 women with uterine ruptures with childbirth in the perinatal centers of the III level of the metropolis. 87.66% of women were assigned to the group of potentially life threatening conditions (PLTC), 12.34% - to the near miss group.

Results. The near miss criterion was hemorrhagic shocks, hysterectomy due to bleeding. The relative risk (RR) of near is higher with uterine rupture during pregnancy [RR = 4.93 (2.0-12.19)], complete uterine rupture [RR = 11.33 (2.71-47.36)] if necessary delivery by CS [RR = 3.03 (1.15-7.99)], especially if there are antenatal signs of a threatening or incipient uterine rupture [OR = 21.67 (9.77-48.04)]. Fetal weight significantly less with near miss than with PLTC (p<0.05). The weight of a newborn <4000 kg does not exclude the risk of uterine rupture. The score of Apgar^/s newborn condition during vacuum extraction of the fetus was significantly lower than with natural childbirth (p<0.05) An inverse correlation between the length of the gap and Apgar score was established. The blood loss in the PLTC group is associated with the state of the newborn. The coefficients of the discriminant function equation are calculated, which make it possible to assess the likelihood of PLTC or near miss at rupture of the uterus. Developed models for the mathematical prediction of near miss upon rupture of the uterus, based on binary logistic regression.

Conclusion. Uterine rupture can cause near miss for the mother and newborn, be the result of iatrogenic in relation to the mother (previously uterus surgery, ineffective postoperative rehabilitation or its absence, which caused uterine rupture during subsequent pregnancy, obstetric aggression in preparation for childbirth and delivery) and fetus (prematurity, hypoxic-ischemic disorders caused by birth trauma, uterine rupture or bleeding).

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

References

1. Radzinskij V.E. Obstetric aggression, v. 2.0. Moscow: StatusPrae-sens, 2017: 872 p. (in Russian).

2. Radzinsky V., Fuks A., Gagaev Ch. Obstetrics. Textbook. Moscow: GEOTAR-Media, 2019. 876 p.

3. Spontaneous delivery of patients with a scar on the uterus after a cesarean section. Clinical protocol. Akusherstvo i ginekologiya [Obstetrics and gynecology]. 2016; 12: 12-19. (in Russian).

4. Statistical Yearbook 2017. Ministry of Healthcare of the Russian Federation). URL: https://www.rosminzdrav.ru/ministry/61/22/stranitsa-979/statisticheskie-i-informatsionnye-materialy/statisticheskiy-sbornik-2017-god (in Russian).

5. 11^th revision of the International Classification of Diseases (ICD) URL: https://icd.who.int/ ).

6. Say L., Souza J.P., Pattinson R.C. WHO working group on Maternal Mortality and Morbidity classifications. Maternal near miss - towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol. 2009; 23: 287-96.

7. Rocha Filho E.A., Costa M.L., Cecatti J.G., Parpinelli M.A., Haddad S.M., et al. Contribution of antepartum and intrapartum hemorrhage to the burden of maternal near miss and death in a national surveillance study. Acta Obstet Gynecol Scand. 2015; 94: 50-8.

8. Conducting a maternal near-miss case review cycle at hospital level (2016) Manual with practical tools. WHO. 2016. Denmark. 82 p.

9. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. GBD 2016 Causes of Death Collaborators. Lancet. 2017; Vol. 390 (10100): 1151-210. doi: 10.1016/S0140-6736(17)32152-9.

10. De Mucio B., Abalos E., Cuesta C., Carroli G., Serruya S., Giordano D., Martinez G., Sosa C. G., Souza J. P., and the Latin American Near Miss Group (LANe-MG)Maternal near miss and predictive ability of potentially life-threatening conditions at selected maternity hospitals in Latin America. Reprod Health. 2016; 13: 134. doi: 10.1186/s12978-016-0250-9.

11. Evaluating the quality of care for severe pregnancy complications: the WHO near-miss approach for maternal health. World Health Organization. 2011. 30 р.

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