A clinical study on ruptured uterus: assessment of treatment approach and maternal and fetal outcome

Nilesh Dalal, Mansi Tiwari


Background: Uterine rupture is a grave condition which is almost fatal for fetus. Various factors contribute to rupture uterus which include poor socioeconomic condition, uncontrolled fertility, illiteracy, adolescent marriage and contracted pelvis. The main objective of the study was to evaluate the incidence of rupture uterus, its etiology, risk factors, complications, treatment strategies, maternal and fetal outcome and to test the association between cause of rupture uterus and gravidity

Methods: This study was conducted over a period of 2 years from July 2015 to August 2017, in the Department of Obstetrics and Gynecology, M.Y. Hospital Indore (M.P.). All cases of rupture uterus, who were either admitted with or who developed this complication in the hospital, were included in the study. Diagnosis was made on history and examination and was confirmed on laparotomy.

Results: In this study the incidence of rupture uterus was 0.289%. Total number of deliveries conducted during this period was 21782 and number of cases with rupture uterus were 63. About 90% of cases belong to age group of 21-30 years. About 62% of cases belong to rural area and 81% of cases were unbooked. In the study 41% of cases were third gravida and 27% were second gravida. About 46 % cases with previous 1 section and 20.7% cases came with obstructed labour. About 17.4% and 4.4% underwent Subtotal and Total hysterectomy respectively. However,78% cases underwent repair of uterine tear.

Conclusions: All patients with primary caesarean section MUST have institutional deliveries. Patients who wish to; and have a favorable condition should be offered TOL (trial of labour) for VBAC, but under strict vigilance.


Rupture uterus, TOL, VBAC

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Ofir K, Sheiner E, Levy A, Katz M, Mazor M. Uterine rupture: risk factors and pregnancy outcome. Am J Obstet Gynecol. 2003;189(4):1042-6.

Smith JG, Mertz HL, Merrill DC. Identifying risk factors for uterine rupture. Clin Perinatol. 2008;35(1):85-99.

Farmer RM, Kirschbaum T, Potter D, Strong TH, Medearis AL. Uterine rupture during trial of labor after previous cesarean section. Am J Obstet Gynecol. 1991;165(4):996-1001.

Miller DA, Diaz FG, Paul RH. Vaginal birth after cesarean: A 10-year experience. Obstet Gynecol. 1994;84(2):255-8.

Nkemayim DC, Hammadeh ME, Hippach M, Mink D, Schmidt W. Uterine rupture in pregnancy subsequent to previous laparoscopic electromyolysis. Case report and review of the literature. Arch Gynecol Obstet. 2000;264(3):154-6.

Miller DA, Goodwin TM, Gherman RB, Paul RH. Intrapartum rupture of the unscarred uterus. Obstet Gynecol. 1997;89(5):671-3.

Mahbuba D, Alam IP. Uterine rupture - Experience of 30 cases at Faridpur medical college hospital. Faridpur Med Coll J. 2012;7(2):79-81.

Eden RD, Parker RT, Gall SA. Rupture of the pregnant uterus: A 53-year review. Obstet Gynecol. 1986;68(5):671-4.

Gardeil F, Daly S, Turner MJ. Uterine rupture in pregnancy reviewed. Eur J Obstet Gynecol Reprod Biol. 1994;56(2):107-10.

Waterstone M, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity: Case-control study. BMJ. 2001;322(7294):1089-93.

Sunitha K, Indira I, Suguna P. Clinical study of rupture uterus-Assessment of Maternal and fetal outcome. J Den Med Sci. 2015;14(3):39-45.

Rashmi G, Radhakrisknan NB, Vaid N. Agarwal. Rupture uterus--changing Indian scenario. J Indian Med Assoc. 2001;99(11):634-7.

Sahu L. A 10-year analysis of uterine rupture at a teaching institution. J Obstet Gynaecol India. 2006;56(6):502-06.

Hamilton EF, Bujold E, McNamara H, Gauthier R, Platt RW. Dystocia among women with symptomatic uterine rupture. Am J Obstet Gynecol. 2001;184(4):620-4.

Chazotte C, Cohen WR. Catastrophic complications of previous cesarean section. Am J Obstet Gynecol. 1990;163(3):738-42.

Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004;351(25):2581-9.

American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 115: Vaginal birth after previous cesarean delivery. Obstet Gynecol. 2010;116:450-63.

Garnet JD. Uterine rupture during pregnancy. An analysis of 133 patients. Obstet Gynecol. 1964;23(6):898-905.

Garnet JD. Uterine rupture during pregnancy. An analysis of 133 patients. Obstet Gynecol. 1964;23(6):898-905.

Sheth SS. Results of treatment of rupture of the uterus by suturing. J Obstet Gynaecol Br Commonw. 1968;75(1):55-8.

Ag├╝ero O, Kizer S. Obstetric prognosis of the repair of uterine rupture. Surg Gynecol Obstet. 1968;127(3):528-30.

Holmgren C, Scott JR, Porter TF, Esplin MS, Bardsley T. Uterine rupture with attempted vaginal birth after cesarean delivery: Decision-to-delivery time and neonatal outcome. Obstet Gynecol. 2012;119(4):725-31.