PREMATURE RUPTURE OF MEMBRANES IN FULL-TERM PREGNANCIES AS A RISK FACTOR OF UTERINE CERVIX RUPTURES IN CHILDBIRTH
Authors:   Saratov State Medical University, KHVOROSTUKHINA NATALIA F. , BAKHMACH VLADISLAV O. ,   Saratov State Medical University, TRUSHINA OKSANA V. ,   Saratov State Medical University, KOLESNIKOVA EKATERINA A. ,   Saratov State Medical University, ODNOKOZOVA OKSANA S. ,   Saratov State Medical University, CHUPAKHIN RUSLAN V. ,   Saratov State Medical University
Published: March 2024

Abstract. Introduction. Premature rupture of membranes continues to be one of the urgent problems in modern obstetrics, since it is exactly the pathology a high frequency of unfavorable pregnancy outcomes is associated with. At the same time, an equally important task in obstetrics and gynecology remains the problem of maternal birth injuries, including cervical ruptures, the frequency of which ranges 6 to 15 %. Aim. To study how premature ruptures of membranes in full-term pregnancies aﬀect the frequency of cervical ruptures in childbirth and to identify the risk factors of cervical injuries in at-term labor complicated by premature rupture of membranes. Materials and Methods. A retrospective analysis of birth histories for the years 2019-2020 was carried out according to the data of the perinatal center at Saratov City Clinical Hospital No. 8. The study group included 894 histories of single at-term vaginal deliveries complicated by premature rupture of membranes, while the control group included 6,735 birth histories of women whose vaginal deliveries were performed with timely ruptures of membranes. Later, we identiﬁed subgroups within the study group: Subgroup 1 (n=101) included patients with premature rupture of membranes at full-term gestation, whose at-term labors were complicated by uterine cervix ruptures, while Subgroup 2 (n=336) included women with premature ruptures of membranes during at-term labors without any maternal birth traumas. When analyzing medical records, special attention was paid to the anamnesis details and to the special aspects of birth courses and outcomes. Statistical data processing was performed using the MS Excel and Statistica 7.0 software programs. Diﬀerences in indications were considered statistically signiﬁcant at p<0.05. Results and Discussion. Probability of premature ruptures of membranes during full-term pregnancy increases in patients expecting their ﬁrst childbirth by 1.6 times (χ2 = 173.49; p <0.001), those with a burdened obstetric/gynecological history, such as abortions, miscarriages, and genital pathology, and those with concomitant extragenital diseases (85.9%). In the study group, we identiﬁed an increase in the incidence of labor anomalies (by 3 times) and acute fetal distress (by 1.9 times), which increased the proportion of using surgical aids in childbirth (by 2.7 times) and the risk of obstetric injuries to the mother (by up to 63.4%), including uterine cervix ruptures by up to 11.3%. Conclusions. Premature rupture of membranes at full-term gestation increases the risk of uterine cervix ruptures in childbirth by 10.3 times. In this obstetric context, the uterine cervix rupture risk factors should include the ﬁrst birth (57.4%; p= 0.003) in the absence of biological readiness of the birth canal (“unripe” or “insuﬃciently ripe” uterine cervix, 76.2%), development of ineﬀective uterine contractions (12.9%), and the use of surgical aids in delivery (vacuum-assisted deliveries and episiotomies, 32.7%).