Uterine rupture is rarer than previously thought

The risk of uterine rupture in pregnancy and labour is very small and lower than previously thought, according to a new UK Obstetric Surveillance System (UKOSS) study. Most cases of uterine rupture happen in women who've had a caesarean section before. However, the UKOSS researchers found that the risks remain small even in women planning a normal birth after a previous caesarean – though they are higher than those that opt for another caesarean. They say that there is no need to change current guidance on birth after a previous caesarean, which is that women should be able to plan the birth they feel most happy with, after discussing the risks and benefits of caesarean and vaginal birth with their doctors and midwives. 'Uterine rupture is a severe but thankfully very rare complication. We found that many of the hospital maternity units across the country don't even see one case a year,' says Professor Marian Knight of the National Perinatal Epidemiology Unit at Oxford University, who led the study. 'Among women who've had a previous caesarean, there is a higher risk for those planning a normal birth rather than another caesarean. But the risk remains very small, occurring in just 0.2% of such pregnancies.' She adds: 'Given that this figure is lower than many previous estimates, there should be no extra reason to worry. We see no reason to change current advice that women can choose how they would like to have their baby after a previous caesarean, and that in general a vaginal birth should be possible.' The study is published in the journal PLoS Medicine and was funded by the UK charity Wellbeing of Women and a National Institute for Health Research (NIHR) Programme Grant. The Oxford researchers found that uterine rupture occurs in just 2 in 10,000 pregnancies in the UK – confirming that this is a rare complication. The vast majority of cases (139 out of 159) were in women who'd had previous caesarean sections. Uterine rupture is still rare among women who have had a previous caesarean section and plan to have a normal birth at 21 per 10,000 pregnancies. But this is higher than in those who elect for another caesarean section, where the incidence is 3 per 10,000 births.
Professor Knight adds: 'Uterine rupture is not the only complication that should be taken into account when planning births following a previous caesarean delivery. These findings need to be considered alongside other small risks and benefits of either vaginal or caesarean birth. This is why it should be an individual choice for women in consultation with their midwives and doctors.
'While there may be an increase in risk of uterine rupture in planning normal birth after a caesarean, electing to have another caesarean can have other associated risks. C-sections are very safe operations but there are small short-term risks of infection or blood clots, there is the often longer recovery period and there are consequences for subsequent births. For example, the more caesareans you have, the more likely hysterectomy and uterine rupture becomes.'
The researchers compared outcomes for the uterine rupture cases with those for a control group of 448 women giving birth after previously having had a caesarean section.
Other factors that were associated with increased risk of uterine rupture were the number of previous caesarean sections the mother had had; a short time since the previous caesarean delivery; and induction of labour.
Professor Knight explains what can be taken from these findings: 'For women who have had a caesarean section, what may be the most useful thing to know is that you will have a lower risk of uterine rupture if you wait at least 12 months before conceiving again.'
She adds: 'Obstetricians and midwives can now be aware that, although rare, inducing labour, or using oxytocin to strengthen contractions, is associated with greater risk of uterine rupture. We now have a good measure of the size of that risk, enabling this information to be put into perspective when discussing birth options with women.'
For more information please contact Professor Marian Knight on +44 (0)1865 289727 or marian.knight@npeu.ox.ac.uk
Or the University of Oxford press office on +44 (0)1865 280530 or press.office@admin.ox.ac.uk
Notes to Editors

* Uterine or womb rupture, a rare complication where the womb wall tears open, occurs most often in labour when the womb is under pressure and contracting. Although it is rare, it can be very severe and even life-threatening for mother and child.
Most cases of uterine rupture occur in women who've had a caesarean section before, when the old scar tissue splits.
The seriousness of uterine rupture has led some to wonder whether caesarean sections should be used more often for women who've had a caesarean previously.
* Current advice is that women who've had a caesarean should have a choice in planning either a vaginal or caesarean delivery for subsequent births, but that vaginal birth should be possible and is often encouraged.
However, there has been a lack of definitive data on how often uterine rupture occurs in the UK to be absolutely sure of the risks.
Therefore, the Oxford University researchers set out to accurately measure the incidence of womb rupture.
* In order to get a much better measure of the incidence of womb rupture than previous estimates, the researchers used the UK Obstetric Surveillance System (UKOSS) to identify confirmed cases of uterine rupture across the UK between April 2009 and April 2010.
UKOSS is a national research system that allows comprehensive information to be assembled about pregnancy complications and their care. It collects data from all hospitals with obstetrician-led maternity units in the UK, so it is as complete as possible.
* There were 159 cases of uterine rupture in the 13 months between 1 April 2009 and 30 April 2010. In that time there are estimated to have been around 800,000 births in the UK, giving an estimated incidence of uterine rupture of 2 per 10,000 pregnancies.
Two women with uterine rupture died and there were 18 deaths among the babies that were associated with the uterine rupture event.
* The paper 'Uterine rupture by intended mode of delivery in the UK: a national case-control study' by Kate Fitzpatrick and colleagues is to be published in PLoS Medicine with an embargo of 21:00 UK time / 17:00 US Eastern time on Tuesday 13 March 2012.
View the publication
* The study was funded by the UK charity Wellbeing of Women and a National Institute of Health Research (NIHR) Programme Grant.


My thoughts:
"The seriousness of uterine rupture has led some to wonder whether caesarean sections should be used more often for women who've had a caesarean previously." This causes me to think that perhaps some should wonder whether caesarean sections should be performed as often if the possible consequences, of which uterine rupture is one, are so awful. It is good that someone is realizing that induction and synthetic augmentation of labor contribute to uterine rupture in those who have had a caesarean; now let's take another step.

Written by Daniel 10/4/2010

If I had a million dollars, I would give it to people who needed it for food. I would give it to people who need food because I would have to be one of the people who don’t know what they are going to be able to eat or don’t know if they are going to eat at all that day. Then with a little bit of the million dollars I would donate to science or something like it because I think some of the things they invent are kind of cool and save a bunch of people a lot of money. Then with the last little bit I would put in a metal box and bury it somewhere because some time in the future someone would find it and would be all excited about it and would be able to use it on something they wanted.

Davis Family Fund Issues

I would like to say that I am incredibly grateful for the support we received from the community regarding our August 2^nd accident and Daniel’s death. I never could have expected or hoped for such a response as we witnessed. We received meals for several weeks, were the object of many fundraisers, and were much prayed for. A fund, the Davis Family Fund, was set up for anyone wishing to donate monetarily.

It has been a mere four months and nineteen days since the accident and Daniel’s death. As those of you who have lost a loved one can attest, the pain and anguish and veritable hole in our lives will never go away. We are just now coming to the point where we find out what the insurances are and are not covering. We also have just now been informed that the Davis Family Fund is not going to be further used to assist us in the financial difficulties experienced due to the accident.

It appears that “it has been decided” that a large amount of money has been given to us from the fund and that the rest of it is to be divided up amongst the children who were involved in the accident. For those living, e-bonds will be set up and given to each child upon coming of age. Daniel’s share will be donated to the Hubbardston Center School Playground Fund.

For the record, I had been thinking of donating to the Playground Fund any remaining monies after we had taken care of accident and burial expenses. The money came from the community; I felt that it would only be right and fair to return something to the community.

However, it appears that without consulting with us, other people know better what is needed for our family. When I asked how much money is in the account, the woman I was speaking to, who is one of two people on the account, refused to tell me. Likewise, she would not tell me who exactly had made these decisions.

It took us four months to be able to bury Daniel simply because we wanted to bury him at home and one person did not like the idea. I think it is a shame that one person is now taking something given freely by the community to benefit a family who experienced great tragedy and using it for a purpose for which it was not intended.

Because of the trauma of the accident and the death of our son and brother, the children and adults have been attending grief support groups through the Carriage House in Worcester while awaiting further trauma and grief counseling. Last week, on December 13, as we were leaving a candle lighting ceremony and supper, we were involved in yet another accident. Fortunately, this did not result in the loss of any life but the van will require much work if it is not considered totaled.

This second accident, while not as bad as the first, was still traumatic for everyone involved coming as soon as it did after the first.

Not only are we still coming to terms with Daniel’s death, as we always will be, and the effects of the first accident, now we have the added stress of dealing with the aftermath of the second as well. It would be a great blessing if those who are involved with decision making for the Davis Family Fund would see fit to let us use it as we find necessary rather than attempting to take upon themselves the responsibility of making decisions for a family who is experiencing something I hope they never have to personally experience.

The Bus

I think the bus right is pretty much the same except now I have to walk to the bus stop instead of going to the end of the driveway and the ride is longer. I think it's very stupid that they don't make good french-fries anymore. I don't like taking all my books for all my classes everywhere. I don't use my locker because it's too much work to open it. I liked Friday because I did not get very much homework. I don't like writing unless it's just a little bit at a time. I like math and social studies the most. Actually my favorite subject is lunch. I don't like it when we get a ton of homework. I like when I go to lunch because I don't have to work, no homework, and I can talk to my friends. I don't like that I don't have some classes with friends. But I think over all it's kind of boring.

The first entry in Daniel's 7th Grade Journal, written 9/10/2010

The Egg

I was asleep in my bed one night. It was very dark outside then all of the sudden I heard a knock on the front door. I got up, picked up my flashlight and went to my bedroom door then I made my way down the stairs. At first when I opened the door I thought it was another dead rat that our cat had left there. Then when I shined my light on it I realized that it was shaped like a huge egg. I picked the object up and went back to my room closing the doors quietly so that I wouldn’t wake my parents up. Then I fell asleep again. The next morning I had completely forgot about the egg so I got up, ate breakfast and went to the bus stop. After school I went to put my pack in my room. As I put it down, I saw the egg and remembered what had happened the night before so I got a hammer and cracked the egg. It was empty.

Written by Daniel on 9/17/2010

Daniel, 7th grade

This is Daniel's school picture from last year. I think it is a good one.

Hubbardston health board approves burial on family land Wednesday, November 23, 2011

Wednesday, November 23, 2011

                Hubbardston health board approves burial on family land

HUBBARDSTON — A local family will finally be able to bury their 14-year-old son who was killed three months ago in a car accident in Minnesota.

The Board of Health voted last night to grant a temporary tomb permit which will allow Pamela Roper to bury her son Daniel Davis on family land on Partridgeville Road. The family may, in the future, return to the board for a permanent permit, which would require a town meeting vote.

After the temporary permit was approved, Tomas Larson, chairman of the Board of Health, apologized to Paul Flint, Ms. Roper’s husband, for the process taking so long, but said the board had to abide by a legal opinion issued by town counsel. The process was delayed after town counsel expressed concern about burials on private property. Interim Town Administrator Brian Bullock worked with the family and proposed the temporary tomb permit.

Mr. Flint said last night that when the burial will take place will depend on the weather. With heavy rain expected and a possibility of snow on Saturday, he said the family would wait to see how the weekend weather develops.

— George Barnes