Uterine Rupture: Changing Trends in Obstetrics and Lessons for Obstetricians

Abstract

ABSTRACT Objectives To determine the impact of improved obstetric care on the incidence, risk factors, management modalities and fetomaternal outcome of uterine rupture. Materials and methods Retrospective analysis of clinical records of uterine rupture cases at the department of Obstetrics and Gynecology, Abha General Hospital, Abha, KSA, from January 2007 to January 2012. Outcome measures Maternal and perinatal morbidity and mortality. Results Analysis showed 33 cases of uterine rupture among 34,590 deliveries, the incidence being 1/1048 (0.09%). Majority of the cases (73%) were unbooked. Important risk factors were previous cesarean section (88%) and grand multiparity (80%). Previous one C-section was also found to be an important risk factor (80%) for uterine rupture. Most of the patients were in their 30s. The frequency of complete and incomplete uterine rupture was almost the same (52 and 48% respectively). Total abdominal hysterectomy was required in 9 (27%), repair in 23 (70%) and one (3%) woman underwent subtotal hysterectomy. None of the patients agreed for tubal ligation. Seven (21%) cases were associated with bladder injury and three (9%) had vascular injury. There was no maternal mortality, 11 (33%) intrauterine fetal deaths and a live birth rate was 67%. Conclusion The absolute incidence of uterine rupture has not decreased inspite of the availability of ANC care and facilities for institutional deliveries. Only the etiological profile has changed. Our study found previous C-section as the most important emerging cause for uterine rupture. Reduction in Csection rate, awareness about the signs and symptoms of impending rupture, careful monitoring during induction in a scarred uterus on the part of caregivers and counseling about need for timely booking and importance of institutional delivery are important factors for reducing uterine rupture. How to cite this article Zia S, Rafique M, Rizwan A, Amin AB, Khan T. Uterine Rupture: Changing Trends in Obstetrics and Lessons for Obstetricians. J South Asian Feder Obst Gynae 2012;4(3):155-158.