Introduction
The rate of uterine rupture is increasing worldwide in relation to increased use of caesarean section (CS).1 As a result, an increasing number of women ask for advice regarding a new pregnancy following a complete uterine rupture. Complete uterine rupture, which is often catastrophic, involves all uterine wall layers, including the serosa and membranes.2,3 Much more common is the uneventful partial rupture (dehiscence), which spares the serosa or membranes. In earlier times, hysterectomy was performed in the event of a complete rupture based on the assumption that the uterine wall is so weak that it cannot tolerate a new pregnancy. In 1969, Reyes-Ceja et al.4 found only one new rupture among 22 pregnancies with previous ruptures. Based on this finding, surgical repair of uterine rupture was recommended instead of hysterectomy.
Very few studies have investigated the risk of repeat rupture during pregnancy. Most publications are case reports, in which the rate varies between 0 and 33%.5 However, recent research has conveyed a rate of repeat rupture of 4 to 13.7%.6Current guidelines from the American College of Obstetricians and Gynecologists (ACOG) recommend that elective repeat CS should be scheduled between 36 and 38/6/7 weeks of gestation for pregnant women with a history of uterine rupture, with eventual changes based on individual evaluation (ACOG 2017).7
The aim of the present study was to determine the rate of repeat complete rupture in new pregnancies and the outcomes of such pregnancies. Describing the outcome of these pregnancies may contribute to the individual evaluation of each woman regarding advice on a new pregnancy, follow-up, and timing of delivery.