A two-year analysis of uterine rupture in pregnancy
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20163875Keywords:
Scar dehiscence, Uterine rupture, VBACAbstract
Background: The aim of our study is to analyze cases of rupture uterus in pregnancy by evaluating the risk factors, type and site of rupture, management, and maternal and perinatal outcome associated with it at a tertiary care hospital, allied with Mysore medical college and research institute, Mysore.
Methods: A retrospective study was conducted in the department of obstetrics and gynecology at Cheluvamba hospital allied with Mysore medical college and research institute, Mysore from January 2013- December 2014. All patients attending obstetric emergency care unit at Cheluvamba hospital, Mysore from January 2013 to December 2014 were included in the study. Cases in which emergency caesarean section were performed for suspected rupture uterus was isolated. Amongst them, the relevant history, intra-operative findings and postoperative morbidity and mortality was studied. Those cases in which successful trial of labor was given was also examined and documented.
Results: A total of 28,574 deliveries were conducted at Cheluvamba hospital for the year 2013. During this period, 7455 (26%) cases of lower segment caesarean section were performed. Amongst them, 20 cases of complete uterine rupture were seen with 147 cases of incomplete rupture or scar dehiscence. 16 cases (80%) of them had a prior scar and the remaining 4 cases (20%) had primary or non-scar rupture. Thus the incidence of scar rupture is 0.26%. The incidence of scar dehiscence was 1.97%. 144 cases had VBAC. The incidence of VBAC in our institution was 1.93%. 95% of cases were multigravida, 30% were unbooked and 65% were referred. The main risk factor was scarred uterus (80%). However 20% of cases, primary rupture were seen due to injudicious use of oxytocics (10%) grand multiparity (5%) and forceps in delivery (1%). Repair of uterus was done successfully in 16 cases (80%), 4 cases had to undergo peripartum hysterectomy (20%). There were 2 maternal deaths and 7 still births.
Conclusions: Rupture uterus is still a significant cause of maternal and perinatal morbidity and mortality. Early diagnosis, immediate resuscitation with rapid replacement of blood loss is key to management of such cases.
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