Analysis and discussion of high-risk factors in nine cases of uterine scar combined with complete uterine rupture

Objective: This study aims to investigate the high-risk factors, clinical characteristics, and outcomes of complete uterine ruptures in patients with uterine scars. Methods: The data of nine patients with complete uterine ruptures, who were admitted to Huaian First People's Hospital from January 2015 to December 2017, were retrospectively analyzed. The general information of these patients and courses of treatment were summarized. Results: Among these nine patients with complete uterine ruptures, the induction of labor induced uterine rupture in four patients, placenta implantation induced uterine rupture in one patient, an unknown factor induced uterine rupture in one patient (with a history of artificial abortion), scar rupture occurred after laparoscopic cornual surgery in one patient, and the incision scar of a previous cesarean section ruptured after labor contractions in two patients. Rupture position: Rupture of the uterine body occurred in three patients, rupture of the uterine base occurred in one patient, rupture of the uterine horn occurred in one patient, and scar rupture at the previous incisions at the lower segment of the uterus occurred in four patients. The clinical manifestations were persistent abdominal pain in two patients, irregular lower abdominal pain in four patients, and no obvious abdominal pain in two patients. Six patients had complications with vaginal bleeding, while three patients had no vaginal bleeding. Seven patients underwent uterine rupture repair, while two patients underwent a subtotal hysterectomy. Among the five patients without induced labor, one patient had intrauterine fetal death, while the remaining four patients had good outcomes for newborns. Conclusion: Patients with a cesarean scar pregnancy, who underwent another pregnancy, suffer a high incidence of uterine rupture. The induction of labor with rivanol and misoprostol, placenta previa, multiple cesarean sections, multiple artificial abortions, and a history of gynecological uterine surgery are all high-risk factors for scar uterine pregnancy.