Analysis of uterine rupture at university teaching hospital Pakistan

Abstract

Objective:To determine the risk factors, management modalities, fetomaternal outcome of uterine rupture cases at University teaching hospital in Pakistan.Methods:This retrospective descriptive study was conducted at the Department of Gynaecology and Obstetrics Liaquat University of Medical and Health Sciences (LUMHS) for a period of one year from January 1st to December 31st 2012. Main outcome measures were frequency, age, parity, booking status, risk factors, management modalities, fetal and maternal mortality associated with uterine rupture. The data was collected on pre-designed proforma analysed using SPSS Version 16 statistical package.Results:The frequency of ruptured uteri was calculated to be 0.67%, giving a ratio of 1:148 deliveries. Highest incidence was found in age group 25-30 (44.26%) with mean age of 30.36 years. and parity group 2-3 (57.37%) with mean parity 4.08. The risk factors for ruptured uterus include Caesarean section 43(70.49%), injudicious use of oxytocin 33(54.09%), obstructed labour 15 (24.59%) and multiparty 18 (29.50%). Repair of uterus was performed in 47(77.04%) cases. Maternal case fatality was 5(8.19%), while foetal wastage was 51 (83.60%).Conclusion:This study confirms the existence of a serious preventable obstetric problem, with significant maternal mortality and foetal wastage. Integrated efforts include Health education, focused antenatal care, skilled attendance, avoidance of injudicious use of oxytocin, and need of hospital based deliveries in patients with caesarean section which should be intensified to reduce this drastic obstetrical complication.

Impact of Janani Suraksha Yojana on institutional delivery rate, incidence of rupture uterus and feto-maternal outcome related to uterine rupture

“…But this remaining incidence 1.14% is still very high in comparison to other countries as 0.02% in UK (Fitzpatrick et al), 0.0521% in China (Xiaoxia B et al), 0.67% in Pakistan (Nousheen et al), 0.85% in northern Nigeria (Akaba GO et al), 0.225% in Tanzania (Kidanto HL et al), 1.46% in southern Nigeria (Kelechi et al) and even other parts of India also as 0.07% in Mumbai (Nagarkatti RS et al). [7][8][9][10][11][12] We have observed that rupture uterus occurred much more frequently in unscarred uterus in our study group even after implementation of JSY. This might be due to deliveries conducted by untrained personnel in rural sectors where either proper medical care is still not available or the ill-informed, uneducated patient and family are still reluctant to seek any trained help.…”

“…But the remaining maternal mortality (4.88%) is still higher in comparison to the studies like Xiaoxia B et al (0%), Fitzpatrick et al (1.3%) and lower to studies Akaba et al (14.7%), Nousheen et al (8.19%), Hussain L et al (6.6%). [7][8][9][10] We have observed that perinatal mortality was almost same in both groups i.e 93.93% and 95.12% in group 1 and group 2 respectively. This incidence of fetal case fatality rate is comparable to Akaba et al (90.7%), Kidanto H. L. et al (96.3%) and Nousheen et al (83.6%).…”

“…This incidence of fetal case fatality rate is comparable to Akaba et al (90.7%), Kidanto H. L. et al (96.3%) and Nousheen et al (83.6%). [9][10][11] It is observed that major bulk of patients (60.97%) were not taken care by ASHA at the time of delivery which shows that there is a definite lack of fieldwork at periphery. Probability is that the incidence of rupture uterus and maternal mortality in post JSY period could have decreased more than that of showing today.…”

Unusual Presentation of Silent Uterine Rupture: A Case Report

“…5% -10% of maternal mortality is because of uterine rupture in developing countries (1). 80% -90% of fetuses in these cases could not be survived (2).…”

“…Inadequate antenatal care is a root cause for high incidence of rupture uterus in developing countries. Incidence of uterine rupture is 1:200 to 1: 3000 deliveries (1,3,4) according to level of antenatal care. Rupture of entire uterine wall and direct connection between peritoneal space and uterine cavity is defined as complete rupture.…”