Rupture of the Unscarred Uterus

Uterine Rupture in Resource-Poor Countries

“…67,68 Aggressive manipulation of the uterus (such as the application of forceful fundal pressure) may also be used by untrained traditional birth attendants 3,5,8,20,47,51 or by inadequately trained health care workers, who sometimes attempt to perform heroic obstetric maneuvers (such as internal podalic version or breech extraction, especially of a retained second twin) without adequate resources or supervision. [1][2][3]5,[7][8][9]11,14,16,20,23,26,[31][32][33][34]38,41,53 Many cases of uterine rupture are associated with difficult instrumental delivery 1,2,6,8,15,16,20,23,27,[30][31][32][33][39][40][41]43,50,52 or destructive obstetric procedures such as craniotomy or decapitation of a dead ...…”

“…[1][2][3]5,[7][8][9]11,14,16,20,23,26,[31][32][33][34]38,41,53 Many cases of uterine rupture are associated with difficult instrumental delivery 1,2,6,8,15,16,20,23,27,[30][31][32][33][39][40][41]43,50,52 or destructive obstetric procedures such as craniotomy or decapitation of a dead fetus, which have virtually been abandoned in contemporary Western obstetric practice. [1][2][3]6,8,16,23,27,42 More rarely, uterine rupture may be associated with unusual conditions such as uterine abnormalities (bicornuate uterus 6,…”

“…Review of case series in which bladder injuries were specifically reported shows that roughly 13% of uterine ruptures in lowresource countries also involve the bladder (range, 1.9%-65.3%). 1,2,5,6,8,[12][13][14]16,18,21,22,24,26,30,32,33,39,43,45,47,[50][51][52][53][56][57][58][59]61 If the uterus is ruptured, the integrity of the bladder must be assessed. Many patients with uterine rupture will develop a vesicovaginal fistula, particularly if the rupture is associated with obstructed labor.…”

“…77 Years ago, Thaddeus and Maine 78 observed that most cases of maternal death and severe maternal morbidity occur when pregnant patients do not receive emergency obstetric care in a timely fashion. These authors analyzed the time course from the onset of obstetric complications (such as obstructed labor) to the receipt of lifesaving interventions and described 3 phases of delay that had an adverse obstetric impact: (1) delay in deciding to seek care after the appearance of obstetric complications, (2) delay in arriving at a suitable health care facility, and (3) delay in receiving appropriate care at such a facility. 78 Each of these delays must be overcome if the incidence and prevalence of uterine rupture are to be reduced in low-income countries.…”

Rupture of the Uterus

“…In 1962 Krishna Menon published his classical review of 164 ruptures (an incidence of 1 in 415) from the Institute of Obstetrics & Gynaecology in Madras; this study contains a wealth of information derived from a most extensive experience. An even larger series was reported from the University Clinic in Natal by Boulle and Crighton (1964), who described 174 cases, an incidence of 1 uterine rupture in every 670 deliveries. In the most recent Report from the Rotunda Hospital, Dublin, for the year 1964, there were 6 ruptures of the uterus, an incidence of 1 in every 961 deliveries.…”