Abstract
Background: Uterine rupture is a rare but severe obstetric complication with significant maternal and neonatal consequences. While partial uterine ruptures (PURs) are generally associated with less severe outcomes, complete uterine ruptures (CURs) carry a higher risk of serious impact on both mother and child. The present study aimed to evaluate outcomes and identify risk factors for each type of rupture, and also to define high- and low-risk uterine ruptures based on clinical outcomes. Methods: A retrospective analysis of 112 uterine rupture cases, including 29 CURs and 83 PURs, was conducted at the Women's Hospital of the University of Cologne from October 2010 to January 2021. Results: Maternal outcomes revealed that CUR was associated with higher risks of prolonged hospitalization (p = 0.003), postpartum hemorrhage (p < 0.001), maternal transfusion (p = 0.003), and ICU transfer (p = 0.004) compared to PUR. Neonatal outcomes showed a significantly higher risk of severe acidosis (p < 0.001), low APGAR scores (p < 0.001), NICU transfers (p = 0.004), and resuscitation needs (p = 0.016) in CUR cases. Factors increasing the risk of CUR included pathological CTG (OR = 1.9, 95% CI: 0.99-7.14, p = 0.05), abdominal pain (OR = 2.63, 95% CI: 1.10-6.25, p = 0.03), previous vaginal birth (OR = 7.14, 95% CI: 0.025-20, p < 0.001), and no uterine contractions (OR = 7, 95% CI: 1.21-40.56, p = 0.03). A previous cesarean section significantly increased the risk of CUR (OR = 4.94, 95% CI: 1.38-17.67, p = 0.014), whereas more than two cesarean sections reduced the risk (OR = 0.66, 95% CI: 0.13-3.22, p = 0.61). A comparison of CUR with maternal and neonatal high-risk rupture groups revealed that low gestational age and a history of previous cesarean sections were significant risk factors for neonatal high-risk rupture. Conclusion: Vaginal birth and abdominal pain were identified as key risk factors for CUR, which lead to severe maternal and neonatal outcomes. Recognizing these risk factors can help clinicians optimize risk stratification and decision-making, and enhance monitoring strategies to prevent adverse outcomes.