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.