Rupture of the uterus: a changing picture

Uterine Rupture: A Case Series From a Tertiary Care Center in Northern India

Uterine rupture is a rare, preventable catastrophic condition in obstetrics. It is associated with high fetal and maternal morbidity and mortality. Its timely diagnosis and swift management may result in better outcomes. Here, we study the presentations and outcomes of three cases of ruptured uterus in the third trimester. Three cases of uterine rupture were presented in the Department of Obstetrics & Gynaecology between the 1st of April 2022 and the 31st of March 2023 in the third trimester, at 29, 33, and 37 weeks, respectively. The mean age of the patients was 25.33 (19-29) years. All three patients had a history of scarred uterus and were diagnosed with clinical suspicion of rupture. Other symptoms were hematuria and absent fetal cardiac activity in the second case; in the third case, she had tenderness in her previous cesarean section scar. Two out of three patients required urinary bladder repair and uterus repair. All patients did well after surgery, leading to no mortality. Our case series findings suggest that the clinical presentations of ruptured uterus vary. A history of previous cesarean section, and findings suggestive of peritonitis like tachycardia, shock, pallor, and absence of an intact uterus should raise suspicion of a ruptured uterus. Searching for non-gynecological causes in such clinical presentations might delay the crucial surgical intervention that leads to mortality, morbidity, and future obstetrics function.

Uterine Rupture: A Seven Year Review at a Tertiary Care Hospital in New Delhi, India

Objective:

To identify the obstetric risk factors, incidence, and causes of uterine rupture, management modalities, and the associated maternal and perinatal morbidity and mortality in one of the largest tertiary level women care hospital in Delhi.

Materials and Methods:

A 7-year retrospective analysis of 47 cases of uterine rupture was done. The charts of these patients were analyzed and the data regarding demographic characteristics, clinical presentation, risk factors, management, operative findings, maternal and fetal outcomes, and postoperative complications was studied.

Results:

The incidence of rupture was one in 1,633 deliveries (0.061%). The vast majority of patients had prior low transverse cesarean section (84.8%). The clinical presentation of the patients with rupture of the unscarred uterus was more dramatic with extensive tears compared to rupture with scarred uterus. The estimated blood loss ranged from 1,200 to 1,500 cc. Hemoperitoneum was identified in 95.7% of the patient and 83% of the patient underwent repair of rent with or without simultaneous tubal ligation. Subtotal hysterectomy was performed in five cases. There were no maternal deaths in our series. However, there were 32 cases of intrauterine fetal demise and five cases of stillbirths.

Conclusions:

Uterine rupture is a major contributor to maternal morbidity and neonatal mortality. Four major easily identifiable risk factors including history of prior cesarean section, grand multiparity, obstructed labor, and fetal malpresentations constitute 90% of cases of uterine rupture. Identification of these high risk women, prompt diagnosis, immediate transfer, and optimal management needs to be overemphasized to avoid adverse fetomaternal complications.