A 10-Year Population-Based Study of Uterine Rupture:

A four-year review of uterine rupture at a secondary health facility in Okitipupa, Southwest Nigeria

OBJECTIVES

Uterine rupture in pregnancy is an obstetric emergency especially in developing countries associated with a significant increase in maternal plus perinatal mortality and morbidity. There is a need to identify the prevalence together with underlining factors which could guide effective intervention. Hence, the study aimed at determining the prevalence of uterine rupture, predisposing factors, management options plus clinical presentation at Secondary Health Facility in Okitipupa, South West Nigeria.

METHODS

This was a retrospective study of patients with a uterine rupture from January 2009 to December 2012 in the Department of Obstetrics and Gynaecology State Specialist Hospital Okitipupa. The case records of patients in this period were retrieved from the medical health records department and relevant data of sociodemographic characteristics, clinical presentation, management as well as maternal and perinatal outcome were collated using a structured questionnaire. Data were analyzed using Microsoft Excel version 10.

RESULTS

Of the 11,377 deliveries during the study period a total of 52 uterine ruptures were recorded during the same period making an incidence of 0.46% or a ratio of 1:219 deliveries. Most of the patients 28 (60.9%) were 20-30 years of age. Uterine rupture was more common amongst multiparous women 36 (78.3%). None was a primigravida. The majority of the patients 34 (73.9%) were nonattendants at the antenatal clinic. The commonest single predisposing factor was the presence of a previous scar being present in 12 (26.1%) of the patients. The most common surgery performed for uterine rupture in the series was repair only 24 (52.2%). There is an absence of uterine rupture in primigravida supports the belief that primigravida is somehow immune to rupture.

CONCLUSIONS

Rupture of the gravid uterus is a major contributor to maternal and perinatal mortality in Okitipupa Southwest Nigeria.

Vaginal birth after cesarean (VBAC): fear it or dare it? An evaluation of potential risk factors

OBJECTIVES

The consultation of women aspiring a vaginal birth after caesarean may be improved by integrating the individual evaluation of factors that predict their chance of success. Retrospective analysis of correlating factors for all trials of labor after caesarean that were conducted at the Department of Obstetrics of Charité-Universitätsmedizin Berlin, Campus Virchow Clinic from 2014 to October 2017.

METHODS

Of 2,151 pregnant women with previous caesarean, 408 (19%) attempted a vaginal birth after cesarean. A total of 348 women could be included in the evaluation of factors, 60 pregnant women were excluded because they had obstetric factors (for example preterm birth, intrauterine fetal death) that required a different management.

RESULTS

Spontaneous delivery occurred in 180 (51.7%) women and 64 (18.4%) had a vacuum extraction. 104 (29.9%) of the women had a repeated caesarean delivery. The three groups showed significant differences in body mass index, the number of prior vaginal deliveries and the child's birth weight at cesarean section. The indication for the previous cesarean section also represents a significant influencing factor. Other factors such as maternal age, gestational age, sex, birth weight and the head circumference of the child at trial of labor after caesarean showed no significant influence.

CONCLUSIONS

The clear majority (70.1%) of trials of labor after caesarean resulted in vaginal delivery. High body mass index, no previous spontaneous delivery, and fetal distress as a cesarean indication correlated negatively with a successful vaginal birth after cesarean. These factors should be used for the consultation of pregnant women.

Maternal and perinatal outcomes of uterine rupture in Lubumbashi, Democratic Republic of Congo

Introduction: Uterine rupture is one of the peripartum complications, which cause nearly about one out of thirteen maternal deaths. This study aimed to assess the prevalence and associated factors of mortality among women with uterine rupture in referral hospitals of Lubumbashi, in the south east part of the Democratic Republic of Congo. Methods: Institution based cross sectional study was conducted from December 1st, 2012 to 31st, 2016 on uterine rupture. During the study selected 158 women were included by using exhaustive sampling method. Data were checked, coded and analyzed into STATA version 12. Chi-square test was used to identify the predictors of maternal and perinatal mortalities in women with uterine rupture and 95% Confidence Interval of odds ratio at p - value less than 0.05 was taken as a significance level. Results: The overall prevalence of uterine rupture was 0.49%. The average age of the patients was 29.5 ± 6.2 years and 71.52% of them were between 20 and 34 years old; more than 60% had a parity ≥4 (average parity: 4.7 ± 2.5). 81.17% of the cases had a fully ruptured uterus and 51.17% of the uterine ruptures were located in the lower segment. Repair of the pregnant ruptured uterus was performed in 93.04% of the cases and hysterectomy in 5.06%. Maternal and perinatal mortalities were 8.86% and 72.04% respectively. Regarding maternal mortality, no parameter showed a significant association with maternal death. As for perinatal mortality, parity ≥4, complete rupture and segmento-corporeal lesion were significantly associated with perinatal death (p < 0.05). Conclusion: Uterine rupture remains one of the causes of maternal and perinatal mortality in Lubumbashi. The place occupied by uterine ruptures in obstetric activity requires joint and urgent action by all stakeholders in the health system in order to combat this scourge, witness to poor quality obstetric care.

Prelabor uterine rupture and extrusion of fetus with intact amniotic membranes: a case report

Introduction: The increasing rate of cesarean sections is an important issue globally, especially in developed countries. During the last decade, despite decreasing rates of vaginal delivery attempts after a previous cesarean section, the risk of uterine rupture has remained. Uterine rupture is a significant and catastrophic obstetric complication associated with maternal and fetal morbidity and mortality. We report here a very rare case of prelabor uterine rupture with intact membranes.

Case report: A 28-year-old, gravida 3, para 2 Turkish woman was referred to our emergency unit at 34 weeks’ gestation because of the absence of fetal movements and abdominal pain. She had had a vaginal birth in 2007 and a cesarean section in 2009. In the delivery room, the fetal extremities were palpated at the abdominal wall, and an ultrasonography revealed ruptured uterus and fetal death. A midline laparotomy was carried out to open the peritoneal cavity. An intact amniotic sac with fetus was observed in the abdominal cavity, and the uterus was also observed to be ruptured. The male fetus, weighing 2500 g, was dead. The rupture was extending from the left lateral side of cervix to the fundus. The tear was repaired by primarily suturing the uterus in two layers after ligation of the left uterine artery to control hemorrhage. The total estimated blood loss was about 1300 mL. The patient received two units of blood transfusion during the operation. In the 4th postoperative day, the patient was discharged.

Conclusion: Complete uterine rupture is a rare but catastrophic event, and if diagnosed late, can result in mortality. Uterine rupture is rare during a trial of vaginal labor in a patient with a history of cesarean section; it is much rarer to occur before any trial of vaginal labor in such a patient. If a patient with a history of cesarean section, especially with an unknown type of incision, presents with complaints of abdominal tenderness or vaginal bleeding in the 3rd trimester, the possibility of complete uterine rupture must be considered.