RUPTURE OF GRAVID UTERUS

A 3 YEARS REVIEW

Abstract

Objective: (1) To evaluate risk factors predisposing to this dreadful event.(2)The modification of
treatment offered.(3)The maternal and perinatal outcome. Setting: Gynae unit I , Nishtar Hospital Multan. Period: From
January 1997 to January 2000. Material & Methods: A total of 34 cases of uterine rupture were seen. Out of these
73.5% were complete ruptures, 26.4% were incomplete ruptures. Ruptures were most commonly seen in anterior lower
uterine segment. Uterine rupture was most commonly seen in patients with scarred uterus, 32.3% had previous one
or two lower uterine segment caesarean section, 5.8% has previous classical caesarean section and another 5.8% had
previous dilatation and curettage. Injudicious of oxytocin, unskilled breech extraction and instrumental delivery,
undiagnosed cephalopelvic disproportion, neglected transverse lie and hydrocephalic were the other causes seen.
Highest number of ruptures were seen in 34-39 years of age group i.e 47.05% . Most of the rupture i.e. 79.4% were
diagnosed during labour and 17.6% were diagnosed during postpartum period. Most of the patients with uterine rupture
had labour pains for the last 9-16 hours. Regarding clinical features majority of patients had tachycardia, pain and
tenderness, fetal heart rate abnormalities, shock, bleeding per vaginum and cessation of uterine contractions.
Depending upon the condition, repair and tubal ligation was the surgical treatment most commonly given, others being
subtotal hysterectomy (32.4%) total hysterectomy (17.6%) and repair without tubal ligation (18.8%) . Regarding
complications, 32.5% had UTI 8.5% had wound infections, 3 patients had cardiac arrest, 2 were resuscitated and one
expired. Among long term complications, vesicovaginal fistula was seen in one patient. Maternal mortality rate of 2.9%
was seen and perinatal mortality rate of 79.4% seen. stillbirth rate was 70.5% and early neonatal deaths within a week
of birth were seen in 8.8% of infants.