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Objective: International comparison of complete uterine rupture.Design: Descriptive multi-country population-based study.Setting: International.Population: International Network of Obstetric Survey Systems (INOSS).Methods: We merged individual data, collected prospectively in nine population-based studies, of women with complete uterine rupture, defined as complete disruption of the uterine muscle and the uterine serosa, regardless of symptoms and rupture of fetal membranes.Main Outcome Measures: Prevalence of complete uterine rupture, regional variation and correlation with rates of caesarean section (CS) and trial of labour after CS (TOLAC). Severe maternal and perinatal morbidity and mortality.Results: We identified 864 complete uterine ruptures in 2 625 017 deliveries. Overall prevalence was 3.3 (95% CI 3.1-3.5) per 10 000 deliveries, 22 (95% CI 21-24) in women with and 0.6 (95% CI 0.5-0.7) in women without previous CS. Prevalence in women with previous CS was negatively correlated with previous CS rate (ρ = -0.917) and positively correlated with TOLAC rate of the background population (ρ = 0.600). Uterine rupture resulted in peripartum hysterectomy in 87 of 864 women (10%, 95% CI 8-12%) and in a perinatal death in 116 of 874 infants (13.3%, 95% CI 11.2-15.7) whose mother had uterine rupture. Overall rate of neonatal asphyxia was 28% in neonates who survived.Conclusions: Higher prevalence of complete uterine ruptures per TOLAC was observed in countries with low previous CS and high TOLAC rates. Rates of hysterectomy and perinatal death are about 10% following complete uterine rupture, but in women undergoing TOLAC the rates are extremely low (only 2.2 and 3.2 per 10 000 TOLACs, respectively.) TWEETABLE ABSTRACT: Prevalence of complete uterine rupture is higher in countries with low previous CS and high TOLAC rates. [ABSTRACT FROM AUTHOR]

Objective: Develop a core outcome set of international consensus definitions for severe maternal morbidities.Design: Electronic Delphi study.Setting: International.Population: Eight expert panels.Methods: All 13 high-income countries represented in the International Network of Obstetric Surveillance Systems (INOSS) nominated five experts per condition of morbidity, who submitted possible definitions. From these suggestions, a steering committee distilled critical components: eclampsia: 23, amniotic fluid embolism: 15, pregnancy-related hysterectomy: 11, severe primary postpartum haemorrhage: 19, uterine rupture: 20, abnormally invasive placentation: 12, spontaneous haemoperitoneum in pregnancy: 16, and cardiac arrest in pregnancy: 10. These components were assessed by the expert panel using a 5-point Likert scale, following which a framework for an encompassing definition was constructed. Possible definitions were evaluated in rounds until a rate of agreement of more than 70% was reached. Expert commentaries were used in each round to improve definitions.Main Outcome Measures: Definitions with a rate of agreement of more than 70%.Results: The invitation to participate in one or more of eight Delphi processes was accepted by 103 experts from 13 high-income countries. Consensus definitions were developed for all of the conditions.Conclusion: Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process. These should be used in national registrations and international studies, and should be taken up by the Core Outcomes in Women's and Newborn Health initiative.Tweetable Abstract: Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process. [ABSTRACT FROM AUTHOR]

Objective: The objective was to investigate prevalence, estimate risk factors, and antenatal suspicion of abnormally invasive placenta (AIP) associated with laparotomy in women in the Nordic countries.Design: Population-based cohort study.Setting and Population: A 3-year Nordic collaboration among obstetricians to identify and report on uterine rupture, peripartum hysterectomy, excessive blood loss, and AIP from 2009 to 2012 The Nordic Obstetric Surveillance Study (NOSS).Methods: In the NOSS study, clinicians reported AIP cases from maternity wards and the data were validated against National health registries.Main Outcome Measures: Prevalence, risk factors, antenatal suspicion, birth complications, and risk estimations using aggregated national data.Results: A total of 205 cases of AIP in association with laparotomy were identified, representing 3.4 per 10 000 deliveries. The single most important risk factor, which was reported in 49% of all cases of AIP, was placenta praevia. The risk of AIP increased seven-fold after one prior caesarean section (CS) to 56-fold after three or more CS. Prior postpartum haemorrhage was associated with six-fold increased risk of AIP (95% confidence interval 3.7-10.9). Approximately 70% of all cases were not diagnosed antepartum. Of these, 39% had prior CS and 33% had placenta praevia.Conclusion: Our findings indicate that a lower CS rate in the population may be the most effective way to lower the incidence of AIP. Focused ultrasound assessment of women at high risk will likely strengthen antenatal suspicion. Prior PPH is a novel risk factor associated with an increased prevalence of AIP.Tweetable Abstract: An ultrasound assessment in women with placenta praevia or prior CS may double the awareness for AIP. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Lykke J, Paidas M, Damm P, Triche E, Kuczynski E, Langhoff-Roos J. Preterm delivery and risk of subsequent cardiovascular morbidity and type-II diabetes in the mother. BJOG 2010;117:274–281. Objective Preterm delivery has been shown to be associated with subsequent maternal cardiovascular morbidity. However, the impact of the severity and recurrence of preterm delivery on the risk of specific cardiovascular events and the metabolic syndrome in the mother, have not been investigated. Design National registry-based retrospective cohort study. Setting Women delivering in Denmark from 1978 to 2007. Population Women with a first singleton delivery ( n = 782 287), and with a first and second singleton delivery ( n = 536 419). Methods Cox proportional hazard models, with the gestational age stratified into four groups as primary exposure. We made adjustments for maternal age, year of delivery, hypertensive pregnancy disorders, fetal growth deviation, placental abruption and stillbirth. Main outcome measures Subsequent maternal hypertension, ischaemic heart diseases, thromboembolism and type-II diabetes. Results After a first delivery at 32–36 completed weeks of gestation, the adjusted risk of subsequent type-II diabetes increased 1.89-fold (1.69–2.10) and the risk of thromboembolism increased 1.42-fold (1.24–1.62). Women having a preterm delivery in the first pregnancy and a term delivery in the second had a 1.58-fold (1.34–1.86) increased risk of type-II diabetes and a 1.18-fold (0.96–1.44) increased risk of thromboembolism. Women having two preterm deliveries had a 2.30-fold (1.71–3.10) increased risk of type-II diabetes and a 1.80-fold (1.29–2.50) increased risk of thromboembolism. Conclusions Preterm delivery is independent of other pregnancy complications associated with subsequent maternal overt type-II diabetes and thromboembolism. The recurrence of preterm delivery will augment these risks. [ABSTRACT FROM AUTHOR]