{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:37:11Z","timestamp":1787017031349,"version":"build-2736575974"},"reference-count":40,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2021,11,28]],"date-time":"2021-11-28T00:00:00Z","timestamp":1638057600000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017950","name":"Shanghai Municipal Health Commission","doi-asserted-by":"crossref","award":["GWIV\u201326.2"],"award-info":[{"award-number":["GWIV\u201326.2"]}],"id":[{"id":"10.13039\/100017950","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Hainan Provincial Medical Center Program"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,10,27]]},"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe the epidemiology of uterine rupture in China from 2015 to 2016 and to build a prediction model for uterine rupture in women with a scarred uterus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A multicentre cross-sectional survey conducted in 96 hospitals across China in 2015\u20132016.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Our survey initially included 77 789 birth records from hospitals with 1000 or more deliveries per year. We excluded 2567 births less than 24 gestational weeks or unknown and 1042 births with unknown status of uterine rupture, leaving 74 180 births for the final analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Complete and incomplete uterine rupture and the risk factors, and a prediction model for uterine rupture in women with scarred uterus (assigned each birth a weight based on the sampling frame).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The weighted incidence of uterine rupture was 0.18% (95% CI 0.05% to 0.23%) in our study population during 2015 and 2016. The weighted incidence of uterine rupture in women with scarred and intact uterus was 0.79% (95% CI 0.63% to 0.91%) and 0.05% (95% CI 0.02% to 0.13%), respectively. Younger or older maternal age, prepregnancy diabetes, overweight or obesity, complications during pregnancy (hypertensive disorders in pregnancy and gestational diabetes), low education, repeat caesarean section (\u22652), multiple abortions (\u22652), assisted reproductive technology, placenta previa, induce labour, fetal malpresentation, multiple pregnancy, anaemia, high parity and antepartum stillbirth were associated with an increased risk of uterine rupture. The prediction model including eight variables (OR &gt;1.5) yielded an area under the curve (AUC) of 0.812 (95% CI 0.793 to 0.836) in predicting uterine rupture in women with scarred uterus with sensitivity and specificity of 77.2% and 69.8%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The incidence of uterine rupture was 0.18% in this population in 2015\u20132016. The predictive model based on eight easily available variables had a moderate predictive value in predicting uterine rupture in women with scarred uterus. Strategies based on predictions may be considered to further reduce the burden of uterine rupture in China.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-054540","type":"journal-article","created":{"date-parts":[[2021,11,29]],"date-time":"2021-11-29T11:11:22Z","timestamp":1638184282000},"page":"e054540","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Epidemiology of uterine rupture among pregnant women in China and development of a risk prediction model: analysis of data from a multicentre, cross-sectional study"],"prefix":"10.1136","volume":"11","author":[{"given":"Wenqiang","family":"Zhan","sequence":"first","affiliation":[{"name":"Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China"},{"name":"School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Zhu","sequence":"additional","affiliation":[{"name":"The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"},{"name":"Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolin","family":"Hua","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangfeng","family":"Ye","sequence":"additional","affiliation":[{"name":"KK Women's and Children's Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Chen","sequence":"additional","affiliation":[{"name":"Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1706-1611","authenticated-orcid":false,"given":"Jun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Hainan Women and Children's Medical Center, Haikou, Hainan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,11,29]]},"reference":[{"key":"2025120518134430000_11.11.e054540.1","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1111\/1471-0528.14833","article-title":"Defining definitions: a Delphi study to develop a core outcome set for conditions of severe maternal morbidity","volume":"126","author":"Schaap","year":"2019","journal-title":"BJOG"},{"key":"2025120518134430000_11.11.e054540.2","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-011-1977-8"},{"key":"2025120518134430000_11.11.e054540.3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002494"},{"key":"2025120518134430000_11.11.e054540.4","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1111\/1471-0528.13394","article-title":"Uterine rupture: trends over 40 years","volume":"123","author":"Al-Zirqi","year":"2016","journal-title":"BJOG"},{"key":"2025120518134430000_11.11.e054540.5","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1007\/s00404-017-4508-4","article-title":"Contemporary epidemiology and novel predictors of uterine rupture: a nationwide population-based study","volume":"296","author":"Vilchez","year":"2017","journal-title":"Arch Gynecol Obstet"},{"key":"2025120518134430000_11.11.e054540.6","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1111\/1471-0528.16363","article-title":"Prelabour uterine rupture: characteristics and outcomes","volume":"127","author":"Al-Zirqi","year":"2020","journal-title":"BJOG"},{"key":"2025120518134430000_11.11.e054540.7","doi-asserted-by":"publisher","DOI":"10.1038\/srep44093"},{"key":"2025120518134430000_11.11.e054540.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.329.7456.19"},{"key":"2025120518134430000_11.11.e054540.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2007.11.008"},{"key":"2025120518134430000_11.11.e054540.10","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1111\/1471-0528.16458","article-title":"Stillbirths in China: a nationwide survey","volume":"128","author":"Zhu","year":"2021","journal-title":"BJOG"},{"key":"2025120518134430000_11.11.e054540.11","unstructured":"Nahun GG , Pham KQ , Chelmow D . Uterine rupture in pregnancy. In: Medscape reference, 2012."},{"key":"2025120518134430000_11.11.e054540.12","unstructured":"Ministry of Health, China . The measures for hospital evaluation. Ministry of Health, China (in Chinese), 2011."},{"key":"2025120518134430000_11.11.e054540.13","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1002\/oby.20995","article-title":"Lower BMI cutoffs to define overweight and obesity in China","volume":"23","author":"He","year":"2015","journal-title":"Obesity"},{"key":"2025120518134430000_11.11.e054540.14","article-title":"Sampling design for the birth in Brazil: national survey into labor and birth","volume":"30 Suppl 1","author":"Vasconcellos","year":"2014","journal-title":"Cad Saude Publica"},{"key":"2025120518134430000_11.11.e054540.15","doi-asserted-by":"publisher","DOI":"10.3758\/s13428-013-0330-5"},{"key":"2025120518134430000_11.11.e054540.16","doi-asserted-by":"crossref","first-page":"30.e1","DOI":"10.1016\/j.ajog.2008.03.039","article-title":"Prediction of uterine rupture associated with attempted vaginal birth after cesarean delivery","volume":"199","author":"Grobman","year":"2008","journal-title":"Am J Obstet Gynecol"},{"key":"2025120518134430000_11.11.e054540.17","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2005.00725.x"},{"key":"2025120518134430000_11.11.e054540.18","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1111\/ajo.13133","article-title":"Uterine rupture over 11 years: a retrospective descriptive study","volume":"60","author":"Chang","year":"2020","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"2025120518134430000_11.11.e054540.19","doi-asserted-by":"crossref","unstructured":"Zhang Y , Betran AP , Li X , et al . What is an appropriate caesarean delivery rate for China: a multicentre survey. BJOG: Int J Obstet Gy 2021;11.doi:10.1111\/1471-0528.16951","DOI":"10.1111\/1471-0528.16951"},{"key":"2025120518134430000_11.11.e054540.20","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1097\/OGX.0000000000000123","article-title":"Uterine rupture in resource-poor countries","volume":"69","author":"Berhe","year":"2014","journal-title":"Obstet Gynecol Surv"},{"key":"2025120518134430000_11.11.e054540.21","doi-asserted-by":"publisher","DOI":"10.1007\/s10974-012-9300-2"},{"key":"2025120518134430000_11.11.e054540.22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0050144"},{"key":"2025120518134430000_11.11.e054540.23","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.1016\/j.ajog.2011.08.013","article-title":"Spontaneous prelabor uterine rupture in a primigravida: a case report and review of the literature","volume":"205","author":"Uccella","year":"2011","journal-title":"Am J Obstet Gynecol"},{"key":"2025120518134430000_11.11.e054540.24","doi-asserted-by":"crossref","first-page":"382.e1","DOI":"10.1016\/j.ajog.2015.05.048","article-title":"Maternal and fetal morbidity associated with uterine rupture of the unscarred uterus","volume":"213","author":"Gibbins","year":"2015","journal-title":"Am J Obstet Gynecol"},{"key":"2025120518134430000_11.11.e054540.25","doi-asserted-by":"crossref","first-page":"107","DOI":"10.2307\/25549722","article-title":"Spontaneous uterine rupture during pregnancy: case report and review of literature","volume":"11","author":"Nkwabong","year":"2007","journal-title":"Afr J Reprod Health"},{"key":"2025120518134430000_11.11.e054540.26","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1111\/1471-0528.12586","article-title":"Intrapartum management of trial of labour after caesarean delivery: evidence and experience","volume":"121","author":"Vusirikala","year":"2014","journal-title":"BJOG"},{"key":"2025120518134430000_11.11.e054540.27","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181eeb251"},{"key":"2025120518134430000_11.11.e054540.28","first-page":"197","article-title":"Planning for labor and vaginal birth after cesarean delivery: guidelines from the AAFP","volume":"91","author":"Hauk","year":"2015","journal-title":"Am Fam Physician"},{"key":"2025120518134430000_11.11.e054540.29","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1097\/AOG.0b013e318249a1d7","article-title":"Uterine rupture with attempted vaginal birth after cesarean delivery: decision-to-delivery time and neonatal outcome","volume":"119","author":"Holmgren","year":"2012","journal-title":"Obstet Gynecol"},{"key":"2025120518134430000_11.11.e054540.30","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-019-2517-y"},{"key":"2025120518134430000_11.11.e054540.31","article-title":"Comparison of maternal-neonatal results of vaginal birth after cesarean and elective repeat cesarean delivery","volume":"92","author":"\u0130zbudak","year":"2021","journal-title":"Ginekol Pol"},{"key":"2025120518134430000_11.11.e054540.32","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1111\/aogs.13504","article-title":"Blood transfusion following intended vaginal birth after cesarean vs elective repeat cesarean section in women with a prior primary cesarean: a population-based record linkage study","volume":"98","author":"Pont","year":"2019","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2025120518134430000_11.11.e054540.33","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.jogoh.2017.12.002","article-title":"French validation and adaptation of the Grobman nomogram for prediction of vaginal birth after cesarean delivery","volume":"47","author":"Haumonte","year":"2018","journal-title":"J Gynecol Obstet Hum Reprod"},{"key":"2025120518134430000_11.11.e054540.34","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1007\/s13224-017-1031-2","article-title":"Predicting successful trial of labor after cesarean delivery: evaluation of two scoring systems","volume":"68","author":"Patel","year":"2018","journal-title":"J Obstet Gynaecol India"},{"key":"2025120518134430000_11.11.e054540.35","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.tjog.2018.04.017","article-title":"Mechanical induction of labor and ecbolic-less vaginal birth after cesarean section: a cohort study","volume":"57","author":"Atia","year":"2018","journal-title":"Taiwan J Obstet Gynecol"},{"key":"2025120518134430000_11.11.e054540.36","doi-asserted-by":"crossref","first-page":"386","DOI":"10.3109\/14767058.2014.916685","article-title":"Pregnancy outcome after induction of labor in women with previous cesarean section","volume":"28","author":"Ashwal","year":"2015","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2025120518134430000_11.11.e054540.37","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s00404-018-4801-x","article-title":"Complicated primary cesarean delivery increases the risk for uterine rupture at subsequent trial of labor after cesarean","volume":"298","author":"Salman","year":"2018","journal-title":"Arch Gynecol Obstet"},{"key":"2025120518134430000_11.11.e054540.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.12.082"},{"key":"2025120518134430000_11.11.e054540.39","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.06.042"},{"key":"2025120518134430000_11.11.e054540.40","doi-asserted-by":"crossref","first-page":"e109","DOI":"10.1016\/S2214-109X(15)00271-5","article-title":"Sociodemographic and obstetric characteristics of stillbirths in China: a census of nearly 4 million health facility births between 2012 and 2014","volume":"4","author":"Zhu","year":"2016","journal-title":"Lancet Glob Health"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-054540","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T02:14:03Z","timestamp":1764987243000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-054540"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11]]},"references-count":40,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11,29]]},"published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1136\/bmjopen-2021-054540"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-054540","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11]]}}}