Induction with prostaglandin and risk of uterine rupture in multiparous
women: a national population-based cohort study
Abstract
Objective To assess whether prostaglandin among multiparous women have
an increased risk of uterine rupture compared to primiparous and women
with one previous delivery. Design Retrospective observational
population-based cohort study. Setting All maternity wards in Sweden
Population Women that have undergone induction with prostaglandin
between May 1996 and December 2019, (n=59,019). Methods The study cohort
was obtained by using data from the Swedish Medical Birth Register,
which contains information from maternity and delivery records. Results
are presented as odds ratios with 95% confidence intervals. Main
Outcome Measures Uterine rupture Results Multiparous women without a
previous caesarean section giving birth after induction with
prostaglandins had an increased absolute risk (0.11%) of uterine
rupture compared to primiparous (0.03%) (crude OR 3.57; 95% Cl
1.49-8.59, p-value 0.004). Multiparous women without a previous
caesarean section had a lower absolute risk (0.04%) of uterine rupture
compared to women with a previous caesarean section (1.62%).
Multiparous women with one previous caesarean section, had a decreased
risk (0.83%) of uterine rupture compared to women with one previous
delivery with caesarean section (2.02%) (crude OR 0.4; 95% Cl
0.21-0.78, p-value 0.006). Conclusion Our study implies that multiparity
is a risk factor for uterine rupture when induced with prostaglandin in
women with no previous caesarean section and this should be taken into
account when deciding on the appropriate method of induction.