Rupture uterus: a prospective observational study of 25 consecutive cases in a tertiary referral centre in South India

Abstract

Background: Uterine rupture in pregnancy is a rare though catastrophic complication with a high incidence of foetal and maternal morbidity. It appeared to be on the decline in recent times, prompting us to analyse the clinical picture now. The objective of the study was to study the risk factors, clinical profile and consequences of uterine rupture on maternal and perinatal outcome.Methods: A prospective observational study of 25 consecutive cases of uterine rupture was carried out between July 2013 and October 2015. All the cases of rupture uterus either referred or diagnosed after admission were included. Detailed demographic data, past and present obstetric events, time taken to reach the referral centre, the reasons for any delay, mode of presentation, type of rupture, management and maternal and foetal outcomes were analysed.Results: The incidence of rupture was 1 in 915 deliveries. Seventy-two per cent of them were referred cases. Average time to reach from referral centre was 4.3 hours, the common reasons for delay being patient factors (33%), transport problems (38%) and delayed referrals (22%). Previous caesarean section was the most common predisposing factor (56%). Sixty-four per cent of the ruptures were diagnosed clinically. Eighty-four per cent of the ruptures were complete. Sub-total hysterectomy was carried out in 14 (56%) patients. Internal iliac artery ligation (20%) and bladder repair (8%) were sometimes required. All women required blood transfusion. Perinatal mortality was seen in 76%. There was no maternal mortality.Conclusions: Uterine rupture is a cause of severe acute maternal morbidity and very high perinatal mortality. Delay in referral and diagnosis can lead to significant maternal morbidity and hysterectomy.

Maternal Deaths due to Obstetric Haemorrhage in Dodoma Regional Referral Hospital, Tanzania

“…This study has highlighted gaps in general management of patients and those with obstetric haemorrhage at DRRH. Like in other studies, it has also shown great contribution of late referral to the deaths of women with haemorrhage [ 17 , 21 , 22 ]. Furthermore, delays in interventions and inadequate skills of providers had also contributed to the deaths.…”

“…This finding further emphasizes on early recognition of women at risk of rupturing uterus and those with poor progress of labour in facilities which cannot perform caesarean section in order to facilitate timely referrals. The problem of referring women already with ruptured uteruses is also frequently seen in other low- and mid-income countries such as India where a study conducted in Karnataka Institute of Medical Sciences showed that 72% of referred women had ruptured uteruses [ 17 ]. However, 5 (21%) women in our study had ruptured uteruses while already at DRRH.…”

Determinants of uterine rupture in Dessie Referral Hospital, North East Ethiopia, 2016: case control design

“…11,13,14 In developed countries the incidence is less than 1 per 1000 deliveries. 15,16 Different studies in Ethiopia showed that the incidence of uterine rupture ranges from 0.3% to 2.4%. 7,9,[17][18][19] Several factors are known to increase the risk of uterine rupture.…”

Epidemiological profile, maternal and neonatal issue of uterine rupture at the Befelatanana Obstetrics and Gynecology University Hospital

“…8 Present result tends to match those of the developed countries whose prevalence is 1% according to Desai and al. 2 This could be explained by the underestimation of the accurate number of cases of the uterine rupture because of cases not recorded in the centre or died before admission. We only recorded uterine rupture after 22 weeks.…”

“…1 The prevalence of uterine rupture tends to decrease in developed countries with a frequency of 1% delivery. 2 However, this major obstetric and surgical emergency still has a high rate in developing countries. In Nigeria, in 2010, the prevalence of uterine rupture was 11.6%.…”