Clinical study of cases of ruptured uterus in pregnancy
Keywords:Caesarean section, Laparotomy, Multiparous, Perinatal mortality, Ruptured uterus
Background: Rupture uterus is a rare and often catastrophic condition. It is associated with a high incidence of fetal and maternal morbidity and mortality. It is a preventable condition. Timely diagnosis and management results in better outcome. The objective of this study was to determine incidence, risk factor, management, maternal and fetal outcome in cases of uterine rupture.
Methods: A retrospective study of cases of ruptured uterus was done over a period of one year from January 2015 to December 2015. The case sheets of patients were traced through labor room register, operation theatre register and medical record section.
Results: There were 57 cases of ruptured uterus out of total 8112 deliveries in labor room, giving incidence of 7.03/1000 deliveries (0.7%). The most common risk factor was previous caesarean section in 59.7% of cases. In 54.4% cases patients were multiparous (≥3). Most of the patients presented with poor general condition, abdominal pain and tenderness, palpable fetal parts and in shock in 68.4% cases. Patients were treated with immediate resuscitation and laparotomy followed by either repair or hysterectomy. There was high perinatal mortality of 89.5%. Maternal mortality was 3.5%.
Conclusions: Proper antenatal care, appropriate counselling of patients with history of previous caesarean section for hospital delivery, training of skilled birth attendant can reduce mortality and morbidity associated with rupture uterus.
Kwast BE, Jiff JM. Factors associated with maternal mortality in Addis Ababa, Ethiopia. Int J Epidemios. 1988;17:115-21.
Kadowa I. Rupture uterus in rural Uganda: prevalence, predisposing factors and outcomes. Singapore Med J. 2010:51:35-8
Philpott RH. Obstructed labor. Clin Obstet Gynaecol. 1982;9:625-40.
Saglamtas M, Vicdan K, Yalcin H, Yilmez Z, Yesilyurt H, Gokmen O. Rupture of the uterus. Int J Gynaecol Obstet. 1995;49:9-15.
Hofmeyr GJ, Say L, Gülmezoglu AM. WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture, BJOG. 2005;112:1221-2.
Smith JG, Mertz HL, Merrill DC. Identifying risk factors for uterine rupture. Clin Perinatol. 2008;35:85-99.
Smith GC, Pell JP, Pasupathy D. Factors predisposing to perinatal death related to uterine rupture during attempted vaginal birth after caesarean section: retrospective cohort study. BMJ. 2004;329:375.
Chariso B. Rupture of pregnant uterus in Shashemene General Hospital. Ethopian Med J. 1995;4:251-7.
Khank, Wajdyl D, Sayl L. WHO analysis of causes of maternal death: a systemic review. Lancet. 2006;367:1066-7.
Bashir A. Maternal mortality in Faisalbad city; a longitudinal study. Gynaecol. 1993;3:14-20.
Lim AC, Kwee A, Bruinse HW. Pregnancy after uterine rupture: a report of 5 cases and review of literature. Obstet Gynaecol Serv. 2005;90:16-37.
Mahbuba, Alam IP. Uterine rupture: experience of 30 cases at Faridpur Medical College Hospital. Faridpur Med Coll J. 2012;7(2):79-81.
Alam I, Khan A, Ahmed R, Begum N. A two-year review of uterine rupture at Gynaecology unit - Ayub teaching hospital. J Ayub Med Coll Abbottabad. 2000;12:21-2.
Rizwan N, Abbasi RM, Uddin SF. Uterine rupture, frequency of cases and fetomaternal outcome. J Pak Med Assoc. 2011;61(4):322-44.
Saini VK, Yadav PA, Munshi SP,. Munshi DS, Marakaja NJ. Study of 30 cases of uterine rupture in teaching institution. Gujarat Med J. 2012;67(2):132-4.
Malik HS. Frequency, predisposing factors and fetomaternal outcome in uterine rupture. J Coll Physicians Surg Pak. 2006;16:472-5.
Rathod S, Samal SK, Swain S. Rupture uterus: a 3-year clinical study. J Clin Diagnostic Res. 2015;9(11): QC04-6.
Sahu L. A 10-year analysis of uterine rupture at a teaching institution. J Obstet Gynaecol India. 2006;56(6):502-6.