Obstetric Uterine Rupture of the Unscarred Uterus: A Twenty-Year Clinical Analysis

Abstract

Background:Rupture of the unscarred uterus is a rare and potentially catastrophic event. We retrospectively reviewed the records of patients with this condition to analyze their obstetric and gynecologic history and evaluate maternal and perinatal morbidity and mortality. Methods:A total of 11 cases of rupture of the unscarred gravid uterus were managed at Mackay Memorial Hospital from January 1984 to September 2003. Data extracted from the records included the use of uterine stimulants, instrumental delivery, and prior abortion by instrumentation, clinical features, treatment, and maternal and fetal morbidity and mortality. Results:The incidence of unscarred uterine rupture is 0.009% during the 20-year study period. The most common contributing factors were prior abortion by instrumentation and the use of uterotonic agents, in three cases respectively. Fetal distress occurred in six cases and postpartum hemorrhage in two. There was no maternal death, but in two cases, there was intrauterine fetal demise or perinatal death. Conclusion:Though unexpected in a woman with an unscarred uterus, rupture should be considered as a possible cause of fetal distress or unusual pain or hypotension in the mother.

Maternal Death After Uterine Rupture in an Unscarred Uterus: A Case Report

“…There have been many postulated factors associated with uterine rupture (10). Multiparity, variably defined as Ͼ 4 or 5 births, has long been considered to place women at higher risk for uterine rupture (11).…”

Rupture spontanée de l’utérus non cicatriciel pendant le travail. À propos d’un cas et revue de la littérature

“…L'usage abusif des ocytociques est également reconnu comme facteur de risque de rupture de l'utérus non cicatriciel, notamment chez les multipares [5,[8][9][10]. Catanzarite et al ont rapporté un cas de rupture spontanée d'un utérus non cicatriciel chez la primigeste en rapport avec une utilisation abusive d'ocytociques (augmentation continue de la dose d'ocytociques jusqu'à 17 mUI/min malgré une hypercinésie de fréquence à la tocométrie) [11].…”

“…La [1,9,10,22,24]. En effet, ces données sont pour la plupart anciennes et difficilement utilisables de nos jours compte tenu des progrès réalisés dans le domaine de la réanimation néonatale.…”

Spontaneous Uterine Rupture during Pregnancy: Case Report and Review of Literature

“…The incidence of rupture of an unscarred uterus varies between 1/8 000 and 1/15 000 pregnancies 9,10 . Most of them occur during labor and can even be due to the application of fundal pressure 9 .…”