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  • Titill er á ensku Uterine Rupture and Factors Associated with Adverse Outcomes
  • Bakkalár
  • Útdráttur er á ensku

    Introduction: Uterine rupture is a rare but serious obstetric complication with a high risk of morbidity for both mother and fetus. It can lead to severe maternal blood loss and extensive damage to the uterus, often necessitating a hysterectomy. Prior cesarean section (C/S) has long been considered the major risk factor for uterine rupture, but in recent years concerns have arisen whether myomectomy is associated with increased risk. The aim of this study was to report characteristics and outcomes of uterine rupture and identify surgical risk factors associated with adverse outcomes. Additional objective was to evaluate how many patients had a history of myomectomy.
    Methods: This study was a retrospective chart review of all cases of complete uterine rupture diagnosed at Brigham and Women‘s Hospital, Massachusetts General Hospital and other Partners Hospitals from 2004 through 2018. Patients were identified from hospital coding records using ICD codes for uterine rupture and data extracted on patient demographics, prior surgical history, obstetric characteristics and outcomes. The data were analyzed using descriptive statistics and multivariable logistic regression used to estimate the association between prior uterine surgeries and severe outcomes. Regression models were adjusted for possible confounders.
    Results: Of the initial 204 patients identified, 75 were excluded because they did not meet the criteria for uterine rupture. Of the remaining 132 cases, 23 (17.4%) patients had an unscarred uterus, and 108 (81.8%) had a history of at least one prior uterine surgery. The majority of these patients (106, 80.3%) had a prior C/S, while 6 patients (4.6%) had a history of myomectomy. 4 patients (3.0%) had a prior C/S as well as a prior myomectomy. Of the 6 cases of uterine rupture after myomectomy, 2 occurred in the same patient with a prior hysteroscopic resection of a pedunculated leiomyoma, 2 patients had prior laparoscopic myomectomy done outside of the USA, and 2 had prior abdominal myomectomy. Adverse outcomes included: 17 hysterectomies (12.8%), 39 blood transfusions (29.6%), 8 fetal or neonatal deaths (6.1%), 18 Apgar scores of lower than 5 at 5 minutes (13.6%), 14 bladder or ureteral injuries (10.6%) and 5 reoperations (3.8%). The mean estimated blood loss (EBL) was 15981765 mL, and 35 women (26.5%) had EBL greater than 1500 mL. Prior uterine surgery was associated with decreased risk of transfusion (OR 0.35, 95% CI 0.14-0.89) and hysterectomy (OR 0.20, 95% CI 0.06-0.73) during uterine rupture compared with an unscarred uterus.
    Conclusion: The majority of the patients had a history of prior uterine surgery, most commonly a C/S. Adverse outcomes occurred in 59 patients (44.7%), but prior uterine surgery was associated with less risk of adverse outcomes. Uterine rupture after myomectomy seems to be a rare event, but women with a history of myomectomy should nevertheless be closely monitored during pregnancy and delivery.

  • 20.5.2019

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