Volume 116, Issue 8 p. 1069-1080
General obstetrics

Uterine rupture in the Netherlands: a nationwide population-based cohort study

JJ Zwart

JJ Zwart

Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands

Department of Obstetrics and Gynaecology, Groene Hart Hospital, Gouda, the Netherlands

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JM Richters

JM Richters

Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands

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F Öry

F Öry

Department of Public Health, TNO Prevention and Health, Leiden, the Netherlands

Pacemaker in Global Health, Amsterdam, the Netherlands

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JIP de Vries

JIP de Vries

Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands

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KWM Bloemenkamp

KWM Bloemenkamp

Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands

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J van Roosmalen

J van Roosmalen

Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands

Section of Health Care and Culture, VU University Medical Centre, Amsterdam, the Netherlands

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First published: 10 June 2009
Citations: 204
Dr JJ Zwart, Department of Obstetrics, K6-P-35, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands. Email [email protected]

Abstract

Objective To assess incidence of uterine rupture in scarred and unscarred uteri and its maternal and fetal complications in a nationwide design.

Design Population-based cohort study.

Setting All 98 maternity units in the Netherlands.

Population All women delivering in the Netherlands between August 2004 and August 2006 (n = 371 021).

Methods Women with uterine rupture were prospectively collected using a web-based notification system. Data from all pregnant women in the Netherlands during the study period were obtained from Dutch population-based registers. Results were stratified by uterine scar.

Main outcome measures Population-based incidences, severe maternal and neonatal morbidity and mortality, relative and absolute risk estimates.

Results There were 210 cases of uterine rupture (5.9 per 10 000 pregnancies). Of these women, 183 (87.1%) had a uterine scar, incidences being 5.1 and 0.8 per 10 000 in women with and without uterine scar. No maternal deaths and 18 cases of perinatal death (8.7%) occurred. The overall absolute risk of uterine rupture was 1 in 1709. In univariate analysis, women with a prior caesarean, epidural anaesthesia, induction of labour (irrespective of agents used), pre- or post-term pregnancy, overweight, non-Western ethnic background and advanced age had an elevated risk of uterine rupture. The overall relative risk of induction of labour was 3.6 (95% confidence interval 2.7–4.8).

Conclusion The population-based incidence of uterine rupture in the Netherlands is comparable with other Western countries. Although much attention is paid to scar rupture associated with uterotonic agents, 13% of ruptures occurred in unscarred uteri and 72% occurred during spontaneous labour.