Publication:

An observational study of uterine rupture at a tertiary care center

Background Uterine rupture is one of the most dangerous obstetric emergency situation carrying an increased risk of maternal and perinatal morbidity and mortality. This catastrophic complication occurs most often in women attempting a vaginal birth after a prior LSCS. Aim was to determine the incidence, etiology, management, maternal and fetal outcome. Recommend strategy for its prevention to reduce the incidence of maternal and fetal morbidity and mortality.

Methods This prospective observational study was conducted over a period of 1 year. Total 51 cases who were diagnosed with rupture were included in the study. Emergency laparotomy after pre-operative resuscitation done. Hysterectomy or repair of rupture site was done depending on the condition of the patient, parity, presence or absence of infection.

Results Maximum patients of uterine rupture belonged to 37-40 weeks of GA. Inter-delivery interval <18-24 week were more vulnerable. Patients with previous caesarean section was more than without section. Maximum cases presented with signs of shock. Maternal death rate was 11.63%, whereas perinatal death rate was 82.35%.

Conclusions Uterine rupture is a major contributor to maternal morbidity and neonatal mortality. Four major easily identifiable risk factors are: history of prior caesarean section, grand multiparity, obstructed labor, and fetal malpresentations. Identification of these high risk women, prompt diagnosis, immediate transfer, and optimal management needs to be overemphasized to avoid adverse feto-maternal complications.