Ruptured uterus: Frequency, risk factors and feto-maternal outcome: Current scenario in a low-resource setup

Abstract

Introduction Pakistan is among the countries with the highest maternal death rates. Obstetric hemorrhage accounts for 41% of these deaths. Uterine rupture is a grave obstetric emergency with high maternal and neonatal morbidity and mortality. It is important to identify its frequency and associated risk factors to formulate programs for its prevention and management. This study aimed to assess the frequency, associated risk factors, fetomaternal outcomes, and management of women with the ruptured uterus at our hospital. Material and methods It was a retrospective study of 206 women to review data collected from cases of uterine rupture managed at the WCTH Bannu, Pakistan from October 2016 to October 2018. A structured proforma was designed and used to extract data from operating theatre registers and the hospital medical records. In our hospital, there is a strong system of maintaining all information of the patients related to demographics, obstetric information, operative notes, and postoperative course during their hospital stay in the patient’s charts. Detailed information on operative procedures is further maintained in the operation theater register and all these registers are checked in the weekly statistical meetings to ensure proper documentation. Data was entered and analyzed in SPSS package version 21 (IBM Corp.; Armonk, NY, USA). Frequency and percentages were calculated for the categorical variables. For inferential statistics, chi-square or Fischer exact tests were used. A p-value of < 0.05 was considered statistically significant. Results The overall incidence of the ruptured uterus was 1.71%. The important etiological factors were grand multiparity 62 (35.2%), obstructed/neglected labour 58 (32.9%), injudicious use of Oxytocin 56 (31.8%) and prostaglandins 26 (14.7%), previous cesarean section 35 (19.8%) and previous pelvic surgery (0.5%). Hysterectomy was done in 80.6% of cases, 34 (19.2%) patients underwent uterine repair and 4.5% had bladder repair. The mortality rate was 21%, mainly due to irreversible shock or disseminated intravascular coagulation. Perinatal mortality was 91.4%. Duration of surgery more than two hours and presentation to the hospital at night time was significantly associated with poor maternal outcome (p = 0.00). Conclusion Uterine rupture is a preventable obstetric emergency associated with high fetomaternal morbidity and mortality. The main causes were grand multigravidity, obstructed labour, previous C-sections and injudicious use of oxytocin and prostaglandins. Women with prolonged surgery and admission at night time had a poor maternal outcome.

Mise à jour thérapeutique et pronostique de la rupture utérine dans une maternité à Bangui, CAR

“… 8 Il en est de même d’autres travaux aux pays à faible revenu dans la littérature qui ont aussi démontré une association entre la RU et la parité. 7 , 9 , 21 Les autres facteurs de risque retrouvés comme la présentation non occipitale et la macrosomie ont aussi été rapportés par d’autres auteurs au Sénégal et à Madagascar. 20 , 22 Les contractions plus prolongées et la forte sollicitation du muscle utérin dont ils sont responsables facilitent sans doute la RU.…”

Ruptur Uteri Komplit Disertai Fetal Death pada Pasien Multipara: Sebuah Laporan Kasus

“…22,23 Kematian ibu berhubungan dengan hipovolemia akibat perdarahan masif dan septikemia, DIC, keterlambatan masuk rumah sakit, dan durasi pembedahan >2 jam (menunjukkan kompleksitas lesi uterus dan kondisi umum pasien yang buruk). 11,24 Secara global, angka kematian perinatal akibat ruptur uteri hampir 11,2%. Ruptur uteri komplit dikaitkan dengan persentase besar kematian intrapartum/bayi, mencapai 26,2% dari total ruptur uteri dalam penelitian selama 40 tahun.…”

Uterine rupture in patients with a history of hysteroscopy procedures: Case series and review of literature

“…The primary high-risk factors for uterine rupture at non-cesarean scar sites predominantly involve concealed scar uterus (involving a history of induced abortion and hysteroscopy surgery), fetal malposition, inadequate development of the uterine muscle layer, anomalous uterine development, external version procedures, multiparity, placental abnormalities, labor induction using drugs, fetal head disproportion, uterine adenomyosis, connective tissue disorders, a history of ectopic pregnancy, and laparoscopic cervical cerclage. [1,[4][5][6] Hysteroscopic surgery is increasingly common and serves an indispensable role in diagnosing and managing intrauterine diseases. Uterine rupture during pregnancy subsequent to hysteroscopic surgery constitutes a long-term complication of these procedures.…”