Rupture uterus in a tertiary care centre
Keywords:Uterine rupture, Previous caesarean section, Perinatal mortality
Background: Rupture uterus is an obstetric life-threatening complication with poor maternal and fetal outcome. The most common risk factor is previous uterine surgeries. Incidence is 0.3/1000 to 7/1000 deliveries in developing countries like India. According to WHO, incidence is 5.35 per 10000 live births. It accounts for 5-10% of maternal deaths. Uterine rupture is associated with significant uterine bleeding, fetal distress and demise, expulsion or protrusion of fetus, placenta or both into the abdominal cavity and need for laparotomy and prompt delivery of the baby, uterine rent repair, or hysterectomy. The objective of this study was to find out the incidence of uterine rupture in Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta and to evaluate its causes.
Methods: This hospital based descriptive study of rupture uterus was conducted over a period of 1 year from January 2021 to December 2021, in the department of obstetrics and gynaecology, Fakhruddin Ali Ahmed Medical College, Barpeta, Assam. All cases of rupture uterus, who were referred from periphery and admitted in our hospital or who developed this complication during hospital stay, were included in the study.
Results: Uterine rupture is one of the most catastrophic complications in obstetrics. The incidence of uterine rupture in our centre was 0.43%. Previous caesarean section accounted for 38.46% of uterine rupture, that too in the lower segment (94.73%). Subtotal/total hysterectomy was done in 30.76% cases and 69.23% cases were repaired. Perinatal mortality was 92.30%, 7.69% of cases were live birth, as these cases were rightly diagnosed, and prompt and timely management was done.
Conclusions: Rupture uterus most commonly occurred in scarred uterus. Identification of high-risk pregnancy, judicious caesarean section, proper labour monitoring with the use of partograph, early diagnosis and prompt management are essential in reducing its occurrences.
Motomura K, Ganchimeg T, Nagata C, Ota E, Vogel JP, Betran AP, et al. Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health. Sci Rep. 2017;7:44093.
Vandenberghe G, Bloemenkamp K, Berlage S, Colmorn L, Deneux-Tharaux C, Gissler M, et al. The International Network of Obstetric Survey Systems study of uterine rupture: a descriptive multi-country population-based study. BJOG. 2019;126(3):370-81.
Fitzpatrick KE, Kurinczuk JJ, Alfirevic Z, Spark P, Brocklehurst P, Knight M. Uterine rupture by intended mode of delivery in the UK: a national case-control study. PLoS Med. 2012;9(3):e1001184.
Turner MJ, Agnew G, Langan H. Uterine rupture and labour after a previous low transverse caesarean section. BJOG. 2006;113(6):729-32.
Mohapatra S, Thanikkal N. A study on rupture uterus. J. Evolution Med. Dent. Sci. 2019;8(32):2554-7.
Sahu L. A 10 year analysis of uterine rupture at a teaching institution. J Obstet Gynecol India. 2006; 56(6):502-6.
Nath P. Uterine rupture- the current scenario in the South Assam. New Indian J OBGYN. 2018;4(2):126-9.
Sunanda N, Priya R. A 2 year Analysis of uterine rupture in pregnancy. Int J Reprod Contracept Obstet Gynacol 2016;5(11):3983-6.
Wang YL, Su TH. Obstetric uterine rupture of the unscarred uterus: a twenty-year clinical analysis. Gynecol Obstet Invest. 2006;62(3):131-5.
Manoharan M, Wuntakal R, Erskine K. Uterine rupture: a revisit .The Obstetrician & Gynaecologist. 2010;12(4):223-30.
Aziz N, Yousfani S. Analysis of uterine rupture at university teaching hospital Pakistan. Pak J Med Sci. 2015;31(4):920-4.
Malik HS. Frequency, predisposing factors and fetomaternal outcome in uterine rupture. J Coll Physicians Surg Pak. 2006;16(7):472-5.
Gul A. Rupture of previously scarred uterus. Ann King Edward Med Coll 2004;10(4):573-5.
Sunanda N, Priya R. A two-year analysis of uterine rupture in pregnancy. Int J Reprod Contracept Obstet Gynecol. 2016;5:3983-6.
Sunitha K, Indira I, Suguna P. Clinical study of rupture uterus – assessment of maternal and foetal outcome. IOSR-JDMS 2015;14(3):39-45.
ACOG Practice bulletin no. 115: Vaginal birth after previous cesarean delivery. Obstet Gynecol. 2010;116(2 Pt 1):450-63.
Sinha M, Gupta R, Gupta P, Rani R, Kaur R, Singh R. Uterine Rupture: A Seven Year Review at a Tertiary Care Hospital in New Delhi, India. Indian J Community Med. 2016;41(1):45-9.
Sahu L. A 10 year analysis of uterine rupture at a teaching institution. J Obstet Gynecol India 2006;56:502-6.
Turgut A, Ozler A, Siddik Evsen M, Ender Soydinc H, Yaman Goruk N, Karacor T, et al. Uterine rupture revisited: Predisposing factors, clinical features, management and outcomes from a tertiary care center in Turkey. Pak J Med Sci. 2013;29(3):753-7.
Shrestha J, Shrestha R. Analyzing uterine rupture: A study from tertiary care centre of western Nepal. J Kathmandu Med Coll. 2015;4(3):95-9.
Mistry S, Sarmalkar M, Nayak AA. Study of maternal outcome in uterine rupture in pregnancy at a Tertiary Care Institute. IJBAR. 2017;8(2):54-60.
Ahmed DM, Mengistu TS, Endalamaw AG. Incidence and factors associated with outcomes of uterine rupture among women delivered at Felegehiwot referral hospital, Bahir Dar, Ethiopia: cross sectional study. BMC Pregnancy Childbirth. 2018;18(1):447.