Grand-multiparity in patients with an unscarred uterus and the risk for uterine rupture: A multicenter cohort study

Hila Hochler, Tamar Wainstock, Eyal Sheiner, Simcha Yagel, Michal Lipschuetz, Yossef Ezra, Asnat Walfisch

Research output: Contribution to journalMeeting Abstract


Uterine rupture is a rare but critical complication. This multicenter cohort study aimed to determine whether grand-multiparity is a risk factor for uterine rupture in patients with an unscarred uterus.

Study Design
A comparison was performed between all singleton deliveries of grandmultiparous (defined as parity of 6 and higher) and singleton deliveries of parous women with 2-5 deliveries. Deliveries occurred between the years 2003-2015 in three medical centers. Patients with previous cesarean deliveries were excluded from the analysis. Multivariable analysis was used to control for confounders.

: A total of 50,334 deliveries of grandmultiparous women were compared with a cohort of 338,456 deliveries with parity of 2-5. Grandmultiparae were significantly older (33.9+/-4.7 versus 27.3+/-5.2 years; P<.0001) and their newborns had higher birth-weight as compared with the comparison group (3321+/-530 gr versus 3169+/-525 gr; P<.0001). During the study period, 14 cases of uterine rupture occurred in grand-multiparous women (an incidence of 2.8:10,000 labors). The crude risk for uterine rupture was significantly higher in grand-multiparous women, with an odds ratio (OR) of 2.2 (95%CI 1.2-4.1; P=0.015). However, while controlling for maternal age in a multivariable model, the association lost its significance (adjusted OR=1.08, 95%CI 1.04-1.1, P=0.344). Prolonged second stage of labor, as well as induction and augmentation of labor, increased the risk for uterine rupture. Grand-multiparous women had higher rates of placental abruption (0.7% vs 0.5%, P<.0001), received more packed cell transfusions (1.3% vs 0.9%, P<.0001) and more often required hysterectomy (P<.0001). Newborns of grand-multiparous women had higher rates of perinatal mortality when compared with those delivered to women with 2-5 deliveries (1.2% vs 0.7%, P<.0001).

Rupture of an unscarred uterus is a rare complication in parous and grand-multiparous women. Maternal age, and not birth-order, was noted as an independent risk factor for uterine rupture.
Original languageEnglish GB
Pages (from-to)S103-S104
JournalAmerican Journal of Obstetrics and Gynecology
Issue number1
StatePublished - Jan 2018


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