Publication:

A clinical study on ruptured uterus: assessment of treatment approach and maternal and fetal outcome

Background Uterine rupture is a grave condition which is almost fatal for fetus. Various factors contribute to rupture uterus which include poor socioeconomic condition, uncontrolled fertility, illiteracy, adolescent marriage and contracted pelvis. The main objective of the study was to evaluate the incidence of rupture uterus, its etiology, risk factors, complications, treatment strategies, maternal and fetal outcome and to test the association between cause of rupture uterus and gravidityMethods: This study was conducted over a period of 2 years from July 2015 to August 2017, in the Department of Obstetrics and Gynecology, M.Y. Hospital Indore (M.P.). All cases of rupture uterus, who were either admitted with or who developed this complication in the hospital, were included in the study. Diagnosis was made on history and examination and was confirmed on laparotomy.

Results In this study the incidence of rupture uterus was 0.289%. Total number of deliveries conducted during this period was 21782 and number of cases with rupture uterus were 63. About 90% of cases belong to age group of 21-30 years. About 62% of cases belong to rural area and 81% of cases were unbooked. In the study 41% of cases were third gravida and 27% were second gravida. About 46 % cases with previous 1 section and 20.7% cases came with obstructed labour. About 17.4% and 4.4% underwent Subtotal and Total hysterectomy respectively. However,78% cases underwent repair of uterine tear.

Conclusions All patients with primary caesarean section MUST have institutional deliveries. Patients who wish to; and have a favorable condition should be offered TOL (trial of labour) for VBAC, but under strict vigilance.