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Master Thesis

La rupture utérine sur utérus sain

Abstract : Objectives. To study the risk factors of unscarred uterine rupture (i.e. without previous gynecology or obstetric uterine scar). Material and methods. Retrospective observational matched case-control study in 5 teaching hospital. Were included all women with uterine rupture occurring during the pregnancy or the labor. Case women were compared with those of women with unscarred uterus without uterine rupture (1:2), controlling for the date and setting of birth, parity, term delivery, mode of labor (spontaneous or induced) and the number of fetus. The primary outcome was the risk factors for uterine rupture. Subgroups analysis were performed according to the viability of fetus. Univariate analysis and adjusted OR were calculated with multivariate logistic regression analyze for predictive factors for uterine rupture. Results. Forty-one patients meeting the inclusion criteria, of those 11 (27,8%) with medical termination of pregnancy/intra uterine fetal death were compared with 82 control patients. A significant higher rate of previous systemic disease was observed in the case group (21.4% vs 2.4%, p<0.05). A non-significant trend of more history of uterine procedure (hysteroscopic, vacuum aspiration, embolization, uterine revision) was observed in the case group (41,4 vs 25%, p=0.07), especially in case of viable pregnancy (43% vs 23,07%, p<0.05). According to the labor characteristics, the mean Bishop score at the induction was lower in the case group (2 vs 4.8, p<0.05). After an adjustment for confounding variables, previous systemic disease and history of uterine procedure were associated with an increased risk of unscarred uterine rupture ((OR 8.692 IC [2.118-35.670]) and (OR 3.183 IC [0,97-1,07] p< 0.05), respectively). A high bishop score was a protective factor (OR 0.734 IC [1,314-5,741], p<0,05). Conclusion. Maternal conditions and history of uterine procedure were associated with the risk of unscarred uterine rupture. Bishop score at the induction was the main obstetric factor associated with uterine rupture. The impact of term delivery and delivery management of medical termination of pregnancy and intra uterine fetal death remained to be specified.
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  • HAL Id : dumas-01588371, version 1

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Meryl Lacorre. La rupture utérine sur utérus sain . Gynécologie et obstétrique. 2017. ⟨dumas-01588371⟩

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