From: Clinical analysis of complete uterine rupture during pregnancy
Serial number | Age (y) | Gestation week (w) | No. of pregnancies | CS-VVF(mm) | Risk factor | Time since previous CS (month) | Location and size of the breach | Bleeding volume (ml) and blood transfusions | Causes and clinical manifestations | Comorbidities and outcomesb | Minimum hemoglobin (g/L) |
---|---|---|---|---|---|---|---|---|---|---|---|
1 | 27 | 33+3 | 2 | 25.8 | CS1, mental retardation | 13 | Original CS scar, 10 cm | intraperitoneal 900, hemorrhage 100 | Bloating 8 + h | stillbirth | 98 |
2 | 35 | 29+1 | 6 | 22.1 | CS1, AA4 | 38 | Multiple large ruptures of the uterus (original CS scar, lower back wall, left side wall) | intraperitoneal 1600, hemorrhage 500 erythrocyte 10 U | Coma total hysterectomy | Stillbirth, traffic accidents | 50 |
3 | 31 | 38 | 7 | 27.5 | VB4, CS2 | 36 | Original CS scar right side, 5 cm | Intraperitoneal 3000, hemorrhage 3000 erythrocyte 14 U, plasma 600 ml | Vaginal hemorrhage after delivery 4 h subtotal hysterectomy | 10′ 3500 g PI | 57 |
4 | 32 | 36+1 | 2 | 38.5 | CS1 (Superimposed Preeclampsia) | 75 | Original CS scar, 2 cm | Intraperitoneal 1500, hemorrhage 200 erythrocyte 6 U, plasma 600 ml | Persistent abdominal pain after spontaneous delivery of a stillborn baby | stillbirth CHWSP | 61 |
5 | 26 | 38+5 | 2 | 26.9 | CS1 | 34 | Original CS scar, 2 cm | intraperitoneal 100, hemorrhage 600 | Painless vaginal bleeding 1 day | 8’-10′ 3300 g CPP + PI | 102 |
6 | 32 | 26+3 | 3 | 22.7 | CS1 (twins, PPH), AA1, 2013 Laparoscopy for EMT | 13 | Original CS scar, 10 cm | intraperitoneal 2000, hemorrhage 2000 erythrocyte 14 U, plasma 1000 ml | Bloating 8 + h total hysterectomy | stillbirth | 70 |
7 | 45 | 29+3 | 6 | 38.5 | VB4, CS1, Double uterus (single cervix, double uterine cavity) | 58 | Right uterine corpus, 15 cm, (up to the uterine fundus and down to the endocervix) | intraperitoneal 2000, hemorrhage 200 erythrocyte 8 U, plasma 600 ml | abdominal pain 7 + h Removal of the body of the uterus on the sick side | stillbirth CH | 69 |
8 | 30 | 29 | 3 | - | VB1 (CPP, PPH), AA1, curettage 1 (retained placenta) | — | Uterine fundus, 10 cm | intraperitoneal 200, hemorrhage 3000 erythrocyte 8 U, plasma 400 ml | Persistent epigastric pain 1 + day total hysterectomy | 9’-10′ 1400 g PI | 43 |
9 | 27 | 33 | 5 | 38.9 | CS1, AA3 | 37 | Original CS scar, 2 cm | intraperitoneal 300, hemorrhage 4000 erythrocyte 14 U, plasma 1600 ml, cold precipitation 12 U | Heavy vaginal bleeding 2 + h total hysterectomy | 10′ 1900 g CPP + PP | 67 |
10 | 29 | 15 | 5 | - | CS2, AA2 | 27 | Original CS scar right side, 3 cm | intraperitoneal 3200, hemorrhage 400 erythrocyte 6 U, plasma 800 ml, cold precipitation 12 U | Persistent left lower abdominal pain 1 day, diarrhea 5 times, Vomit once | stillbirth CSP | 55 |
11 | 32 | 40+2 | 3 | 18.4 | CS1, AA1 | 61 | Left posterior wall near endocervix, 3 cm, vertical | intraperitoneal 50, hemorrhage 200 | — | 10′ 3150 g | 104 |
12 | 29 | 34+3 | 5 | 32.5 | CS2, AA2 | 73 | Original CS scar, 10 cm | intraperitoneal 1000, hemorrhage 200 plasma 1000 ml | Abdominal pain with vaginal drainage 10 h | stillbirth HELLP syndrome | 65 |
13 | 33 | 29+4 | 5 | - | VB2, AA2 | — | Bottom of the uterus near the right uterine horn, 5 cm | intraperitoneal 1500, hemorrhage 200 erythrocyte 4 U | Persistent lower abdominal pain (slightly to the right around the umbilicus) 5 + h | 6’-9’-9′ 1350 g PI, insufficient amniotic fluid | 59 |
14 | 30 | 33 | 7 | 26.7 | CS1 (superimposed preeclampsia), VBAC1, AA3, 2016 Laparoscopic right tubal opening for embryo retrieval | 58(VB 28、IC 13)a | Right uterine fundus, old, 4 cm, covered by large omental adhesions | hemorrhage 1000 | Vaginal bleeding 10 + days | 9’-10′ 1990 g CPP | 101 |
15 | 34 | 26 | 6 | 25.0 | VB2, CS1, AA2 | 46 | Original CS scar right side, 1 cm | intraperitoneal 2000, hemorrhage 1000 autologous blood 750 ml, erythrocyte 4 U, plasma 600 ml, cold precipitation 6 U | Abdominal pain 3 h, ultrasound suggests abdominal fluid | 5’-9’-10′ 1100 g PP、GDM | 69 |
16 | 33 | 35+5 | 7 | 28.2 | CS1 (right uterine horn wedge excision, PPH), AA5 | 62(IC 36)a | Right uterine horn, 3 cm, covered by large omental adhesions | intraperitoneal 50, hemorrhage 300 | Bloating 2 days | 10′ 2650 g wind heart disease; GDM | 117 |
17 | 30 | 40+3 | 4 | - | VB2, AA1 | — | Posterior wall of the uterus near the ligamentum intrinsicum of the left ovary, 6 cm, vertical | intraperitoneal 500, hemorrhage 1000 erythrocyte 8 U | Premature rupture of membranes after multiple intercourse, oxytocin, changes in fetal position and heart rate | 2’-2’-3′ 3600 g | 62 |
18 | 30 | 26+5 | 4 | - | AA3 | — | Left uterine fundus, 1 cm | intraperitoneal 2500, hemorrhage 3000 erythrocyte 12 U, cold precipitation 16 U | abdominal pain with vomiting 7 + h, LMWH | double stillbirth IVF-ET | 52 |
19 | 31 | 21 | 4 | - | VB1, AA2 | — | Right posterior wall near the cervix, 3 cm | intraperitoneal 500, hemorrhage 1000 erythrocyte 6 U | Bloating 2 days | stillbirth | 63 |
20 | 31 | 37 | 4 | - | VB1, AA2 | — | Right side of uterus near round ligament, 6 cm | intraperitoneal 1000, hemorrhage 600 erythrocyte 8 U, plasma 600 ml | Breech delivery, difficulty delivering the fetal head | 3’-4’-4′ 3550 g | 59 |
21 | 37 | 39+1 | 3 | 38.8 | CS1, VBAC1 | 42(VB 24)a | Original CS scar, 2 cm | hemorrhage 200 | intrauterine distress | 10′ 3700 g | 105 |
22 | 30 | 38 | 5 | 18.0 | CS1, AA3, double uterus (single cervix, double uterine cavity) | 30 | Connection of the posterior walls of both uterine cavities, 1 cm | hemorrhage 1500 autologous blood 500 ml, erythrocyte 2 U | — | 10′ 3450 g CPP, transverse fetal position | 82 |
23 | 38 | 23+3 | 7 | 17.6 | CS3 (eclampsia, severe adhesion), AA3 | 26 | Original CS scar near cervix, 3 cm, severe adhesion | intraperitoneal 500, hemorrhage 200 | After mifepristone and misoprostol, abdominal pain with vaginal bleeding 7 h, ultrasound shows uterine rupture | stillbirth CHWSP, GDM | 97 |
24 | 37 | 32 | 9 | - | VB2, AA5, 2015 Laparoscopic Left Tubectomy | — | Uterine fundus, 12 cm | intraperitoneal 2500, hemorrhage 1500 erythrocyte 8 U, cold precipitation 6 U | Abdominal pain 8 h,vomit once, coma 30 min | stillbirth | 76 |
25 | 23 | 34+1 | 5 | 31.6 | VB3, CS1 | 15 | Original CS scar, T-shape, 5 × 3 cm, metal ring | intraperitoneal 500, hemorrhage 500 | Lower abdominal pain with vaginal bleeding 1 day, uterine area tenderness | stillbirth | 100 |
26 | 40 | 38+6 | 3 | 18.6 | CS1, AA1 (CSP) | 156 | Left side of original CS scar, 2 cm | intraperitoneal 50, hemorrhage 400 | Bloating 2 days | 10′ 2850 g adenomyosis, IVF-ET | 91 |
27 | 32 | 38+2 | 5 | 20.5 | CS1 (PI), AA3, 2019 transabdominal cerclage | 13 | Lower part of the posterior uterine wall, 2 cm, left broad ligament, 2 cm | hemorrhage 400 | — | 10′ 3950 g PA | 116 |
28 | 33 | 31+1 | 4 | 21.7 | CS1, AA2 | 84 | Original CS scar, 1 cm | intraperitoneal 500, hemorrhage 200 | Ethacridine, uterine area tenderness, ultrasound shows uterine rupture | stillbirth | 92 |
29 | 36 | 29 | 5 | 19.8 | CS2 (PPH), AA2 | 58 | Original CS scar, T-shape, 4 × 5 cm | hemorrhage 800 erythrocyte 6 U | Ethacridine, uterine area tenderness, ultrasound shows uterine rupture | stillbirth | 71 |
30 | 21 | 39 | 4 | 26.5 | CS3, HIV | 14 | Middle part of anterior wall of uterus, 4 cm | hemorrhage 400 | — | 10′ 2900 g MPP | 80 |
31 | 39 | 37+2 | 4 | - | VB2, AA1, 2018UM | — | Lower part of the anterior wall of the uterus near the left broad ligament, 3 cm | intraperitoneal 50, hemorrhage 600 | — | 10′ 3500 g PPP + P, GDM | 93 |
32 | 37 | 21 | 4 | - | CS1, AA2 | 51 | Anterior wall near the left uterine horn to the endocervical os, 10 cm | intraperitoneal 1200, hemorrhage 200 erythrocyte 4 U, cold precipitation 14 U | Spontaneous labor after stillbirth, uterine area tenderness, ultrasound shows uterine rupture | stillbirth CPP | 78 |
33 | 33 | 32+1 | 3 | 19.9 | CS2 | 53 | Lower part of the posterior uterine wall, 1 cm | intraperitoneal 3000, hemorrhage 1000 erythrocyte 30 U, plasma 5800 ml, cold precipitation 88 U, platelet 36 U | Tachycardia, bloating, shock litogun, LMWH, total hysterectomy | stillbirth, maternal death, PPP + PP, PGDM | 51 |