Gynecology and Reproductive Endocrinology

Uterine Rupture

Rupture of uterus occurs mostly secondary to a previous caesarean section, making this its main risk factor with an incidence of around 1%. The estimated incidence of a rupture of the unscarred uterus is 1/8000 to 15,000 deliveries or, as investigated by the World Health Organization (WHO), 0.006%.  The incidence of uterus rupture in general is significantly higher in developing countries than in developed countries caused by worse antenatal and obstetric care high frequency of home deliveries with prolonged labor, and grand multiparty.Uterine rupture is a rare peripartum complication that occurs in around 7/10 000 individuals, but this rate increases to 20–80/10 000 in mothers with uterine scars, mostly as a result of previous caesarean section.1, 2 The use of caesarean section is increasing worldwide, and thus the rate of uterine rupture is also expected to rise.3, 4 With the potential for catastrophic outcomes, a study is warranted to determine the trend of uterine rupture.

Detecting changes in incidence and outcome of uterine rupture and examining the possible role of certain risk factors may provide deeper insight into the safety of our current obstetric practice. The increasing use of caesarean section, induction of labour with specific methods, and augmentation of labour with oxytocin all play a role in modern obstetrics. The caesarean section rate in Norway increased from 1.8% in 1967 to 16.8% in 2012,5 but there was also a high rate of trial of labour with vaginal births in 51% of mothers with a previous caesarean section.6This study aimed to determine trends in incidence, risk factors, and outcomes of uterine rupture over a period of 40 years (1967–2008), based on two registries and medical records from 21 maternity units in Norway.