Rupture uterus: a prospective observational study of 25 consecutive cases in a tertiary referral centre in South India
Keywords:Maternal mortality, Morbidity, Rupture uterus, Scar uterus
Background: Uterine rupture in pregnancy is a rare though catastrophic complication with a high incidence of foetal and maternal morbidity. It appeared to be on the decline in recent times, prompting us to analyse the clinical picture now. The objective of the study was to study the risk factors, clinical profile and consequences of uterine rupture on maternal and perinatal outcome.
Methods: A prospective observational study of 25 consecutive cases of uterine rupture was carried out between July 2013 and October 2015. All the cases of rupture uterus either referred or diagnosed after admission were included. Detailed demographic data, past and present obstetric events, time taken to reach the referral centre, the reasons for any delay, mode of presentation, type of rupture, management and maternal and foetal outcomes were analysed.
Results: The incidence of rupture was 1 in 915 deliveries. Seventy-two per cent of them were referred cases. Average time to reach from referral centre was 4.3 hours, the common reasons for delay being patient factors (33%), transport problems (38%) and delayed referrals (22%). Previous caesarean section was the most common predisposing factor (56%). Sixty-four per cent of the ruptures were diagnosed clinically. Eighty-four per cent of the ruptures were complete. Sub-total hysterectomy was carried out in 14 (56%) patients. Internal iliac artery ligation (20%) and bladder repair (8%) were sometimes required. All women required blood transfusion. Perinatal mortality was seen in 76%. There was no maternal mortality.
Conclusions: Uterine rupture is a cause of severe acute maternal morbidity and very high perinatal mortality. Delay in referral and diagnosis can lead to significant maternal morbidity and hysterectomy.
Nahum GG, Pham KQ. Uterine rupture in pregnancy; 2011. available from URL http://reference.medscape.com/article/275854.
Cunningham F. In Obstetrical Hemorrhage pp 790-93 and Prior Caesarean Delivery, pp 609-20; Cunningham FG, Leveno KJ, Bloom SL, Spong CY et al (eds.), William’s Obstetrics, 24th edition, by McGraw-Hill Education; 2014.
Gessesse A, Melese MM. Ruptured uterus-eight year retrospective analysis of causes and management outcome in Adigrat Hospital, Tigray region, Ethiopia. Ethiop J Health Dev. 2002;16:241-5.
Gardiel FF, Daly SS, Turner MJ. Uterine rupture in pregnancy reviewed. Eur J Obstet Gynecol Reprod Biol.1994;56:107-10.
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;41:45-9.
Sunitha K, Indira I, Suguna P. Clinical study of rupture uterus- Assessment of Maternal and fetal outcome. IOSR Journal of Dental and Medical sciences/ 2015;14:39-45.
Gupta A, Nanda S. Uterine rupture in pregnancy: a five year study. Archives of Gynaecology and Obstetrics. 2011;283:437-41.
Sahu L. A 10 year analysis of uterine rupture at a teaching institution. J Obstet Gynecol India. 2006;56:502-6
Oronsaye AU, Asuquo EE. Rupture of the uterus in a Nigerian Hospital. Singapore J. Obstet. Gynaecol. 1980;2:37-42.
Rotimi EO, Olamijulo JA. Rupture of the uterus at the Lagos University teaching hospital, Lagos, Nigeria. West Afr. Med. J. 1998.17:188-93.
Hamilton BE, Martin JA, Sutton PD. Births in preliminary data for 2002. Nat Vital Stat Rep. 2003;51:1-20.
Revicky V, Muralidhar A, Mukhyopadhyay S, Mahmood T. A case series of uterine rupture: lessons to be learned for future clinical practice. J Obstet Gynecol India. 2012;62:665-73.
Ehigiegba AE, Adeyemo IS. Uterine rupture in labour: a continuing obstetric challenge in developing countries- the Benin experience. J Med Biomed Research. 2006;5:44-50.
Bujold E, Gauthier RJ. Neonatal morbidity associated with uterine rupture: what are the risk factors? Am J Obstet Gynecol. 2002;186:311-4.
Fofie CO, Baffoe P. A two-year review of uterine rupture in a regional hospital. Ghana Med J. 2010; 44:98-102
Mukasa PK, Kabakyenga J, Senkungu JK, Ngonzi J, Kyalimpa M, Roosmalen VJ. Uterine rupture in a teaching hospital in Mbarara, Western Uganda, unmatched case-control study. Reprod Health. 2013; 10:29.
Rizwan N, Abbasi RM, Uddin SF. Uterine rupture, frequency of cases and feto-maternal outcome. J Pak Med. Assoc. 2011;61:322-4.
Padhye SM. Rupture of the pregnant uterus: A 20 year review. Kathmandu Univ. Med. J.2005; 3:234-8
Omole-Ohonsi and Attah. Uterine Rupture: risk factors and pregnancy outcome. Gynecol. Obstet. 2011;1:102.
Dhaifalah I, Santavy J, Fingerova H. Uterine rupture during pregnancy and delivery among women attending the Al- Tthawra hospital in Sana’a city, Yemen Republic. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2006:150:279-83.
Ofir K, Sheiner E, Levy A, Katz M, Mazor M. Uterine Rupture: differences between a scarred and an unscarred uterus. Am. J. Obstet. Gynecol. 2004;19:425-9.
Al Salem MH, Makhseed M, Ahmed MA, Gupta M. rupture of the gravid uterus: Experience of the maternity Hospital, Kuwait. Med Principles Pract. 2000;9:97-105.
WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture. BJOG. 2005;112:1221-28.