Introduction
The rate of uterine rupture is increasing worldwide in relation to
increased use of caesarean section (CS).1 As a result,
an increasing number of women ask for advice regarding a new pregnancy
following a complete uterine rupture. Complete uterine rupture, which is
often catastrophic, involves all uterine wall layers, including the
serosa and membranes.2,3 Much more common is the
uneventful partial rupture (dehiscence), which spares the serosa or
membranes. In earlier times, hysterectomy was performed in the event of
a complete rupture based on the assumption that the uterine wall is so
weak that it cannot tolerate a new pregnancy. In 1969, Reyes-Ceja et
al.4 found only one new rupture among 22 pregnancies
with previous ruptures. Based on this finding, surgical repair of
uterine rupture was recommended instead of hysterectomy.
Very few studies have investigated the risk of repeat rupture during
pregnancy. Most publications are case reports, in which the rate varies
between 0 and 33%.5 However, recent research has
conveyed a rate of repeat rupture of 4 to 13.7%.6Current guidelines from the American College of Obstetricians and
Gynecologists (ACOG) recommend that elective repeat CS should be
scheduled between 36 and 38/6/7 weeks of gestation for pregnant women
with a history of uterine rupture, with eventual changes based on
individual evaluation
(ACOG
2017).7
The aim of the present study was to determine the rate of repeat
complete rupture in new pregnancies and the outcomes of such
pregnancies. Describing the outcome of these pregnancies may contribute
to the individual evaluation of each woman regarding advice on a new
pregnancy, follow-up, and timing of delivery.