Obstetric Uterine Rupture: A 20-Year Clinical Analysis

Abstract

To analyze the obstetric and gynecologic history of women with uterine rupture during pregnancy, and examine maternal and perinatal morbidity and mortality outcomes after uterine rupture. A retrospective review of patients with rupture of the gravid uterus at Mackay Memorial Hospital, for the period between January 1984 and September 2003, was undertaken. The records of these patients were studied with regard to previous cesarean section, the use of uterine stimulants, the use of instruments in delivery, clinical features, treatment modality, and maternal and fetal morbidity and mortality. A total of 21 cases of rupture of the gravid uterus were found. The prevalence of uterine rupture was 1 in 6,056 deliveries. The most common risk factor was previous cesarean section scar (48%). Fetal distress (43%) and postpartum hemorrhage (24%) were the two most common manifestations of ruptured uterus. Fourteen cases were term pregnancies. However, seven cases presented before term, including one in the first trimester, two in the second trimester, and four in the early third trimester. There was only one maternal death (5%), but five cases (24%) presented with intrauterine fetal demise. Physicians should be alert to the possibility of uterine rupture at all stages of pregnancy. The ability to recognize the various signs of a possible rupture event, such as fetal distress, maternal pain, or hypotension, and then to address the situation immediately, is critical to a good outcome.