Rupture of pregnant uterus: incidence, risk factors, maternal and fetal outcome

Abstract

Objective: To determine the incidence, risk factors, complications, management modalities and maternal and perinatal outcome of rupture uterus in pregnancy. Methods: This retrospective study was carried out at a teaching institute, for a period of 10 years from January 2006 to December 2015. Clinical records of cases of uterine rupture were reviewed and information on demographic characteristics, clinical presentation, intraoperative findings, surgical intervention and maternal and perinatal outcome was collected. Result: Out of 63237 deliveries, 116 cases of rupture uterus were reported with an incidence of rupture uterus 1 in 545. Majority 52 (44.83%) of cases were in age group 26-30 years. Only 1 was primigravida, 16 (13.79%) were of parity > 5 and remaining of parity 1- 4. Majority were unbooked cases. 93 (80.17%) were referred from other health centers and only 23 (19.83%) cases were admitted directly. Uterine scar (58.62%) and obstructed labor (24.13%) were the common risk factors. Anterior uterine wall of lower uterine segment was the most common site of rupture. Repair of rupture site with or without bilateral tubal ligation was done in 60 (51.72%) cases, while subtotal hysterectomy was performed in 46 (39.65%) cases. Hypovolumic shock was the major cause of maternal death. Conclusion: Promotion of skilled attendance at birth, identification of high risk women and timely referral, use of oxytocic drugs cautiously , correct use of partograph, preventing unnecessary caesarean sections and education of people about supervised pregnancy and delivery are essential in reducing the occurrences of uterine rupture.