Interpretation
Infection as a risk-factor for uterine rupture has not been studied in
detail in the past. To the best of our knowledge, our cohort of 71 cases
of uterine rupture is the largest to explore this subject, including 40
cases of complete rupture and 31 cases of dehiscence, as well as 97
controls.
Lieberman et al.7 found a correlation between
infection and rupture. The rate of postpartum fever of any kind was 38%
(8/21) in the uterine rupture group compared to 15% (13/84) in the
control group (p=0.03).8 Like our study, no
statistical difference in the intrapartum fever group was found. They
reviewed a database of patients from 1984 to 1996, with 70-75%
receiving antibiotic prophylaxis. Our results are based on deliveries
from 2014 to 2022, with 100% prophylaxis treatment according to ACOG
guidelines and a very organized, prospective data collection system,
based on ICD-9 codes and on detailed review of the EMR.
Gabbay‑Benziv et al. found a correlation between complications at first
CD (infection, post-partum haemorrhage) and uterine rupture during TOLAC
(p= 0.042).17 They had 3 cases of infection, all of
which were postpartum fever documented during postpartum admission (4
days). In our study, 24 cases of infections were documented, 13 of which
were diagnosed after readmission due to symptoms of infection.
Vilchez et al. used a large database of patients, and found that
chorioamnionitis during the index delivery is a risk-factor for uterine
rupture (odds ratio 5.7).18 They concluded that this
was probably due to the association with protracted labour. Our study
explored the impact of the infection itself on the uterine scar,
evaluated at the next delivery.