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

BJOG. 2009 Jul;116(8):1069-78; discussion 1078-80. doi: 10.1111/j.1471-0528.2009.02136.x.


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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cicatrix / complications
  • Delivery, Obstetric / adverse effects
  • Female
  • Humans
  • Middle Aged
  • Netherlands / epidemiology
  • Pregnancy
  • Prospective Studies
  • Risk Factors
  • Socioeconomic Factors
  • Trial of Labor
  • Uterine Rupture / epidemiology*
  • Vaginal Birth after Cesarean / statistics & numerical data
  • Young Adult