Uterine Rupture at LUMHS: A Review of 85 Cases

OBJECTIVE: To evaluate risk factors, management and pregnancy outcome of patients with uterine rupture at teaching hospital DESIGN: Prospective observational study. SETTING: Obstetrical and Gynecology Unit II, Liaquat University Hospital Hyderabad-Pakistan; from 1st January 2004 to 31st December 2007. PATIENTS AND METHODS: All patients diagnosed as case of intrapartum uterine rupture were approached. A pre-designed proforma was used to collect the demographic features, predisposing risk factors, management and feto-maternal outcome. Data fed to SPSS program version 10 to analyse the results. RESULTS: Total maternity admissions were 12678 with 11961 deliveries. A total number of 85 cases of uterine rupture were identified, giving a ratio of 0.7% or 1:141 deliveries. There were 46 cases in scarred and 39 cases with unscarred uteri. Highest incidence was found in age group 25-30 years (57.6%) and in parity group 1-3 (62.3%). Misuse of oxytocics (85.8%), scarred uterus (54.1%), obstructed labour (42.3%) and grand multiparty (21%) were found as main predisposing factors. Uterine repair was done in 61% of cases while hysterectomy was performed in 39% cases. Bladder repair was additionally required in 9.5% of cases. There were 6 (7%) maternal and 64 (75%) perinatal deaths due to uterine rupture. CONCLUSION: Uterine rupture is yet a common obstetrical emergency in our area. The significant morbidity and mortality deserves our special attention by a collaborative approach. Regular antenatal checks, careful selection of patients for vaginal delivery, vigilantly monitored labour with smooth switch-over to operative delivery can reduce this drastic obstetrical complication.