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Madhuri MS, Jha N, Pampapati V, Chaturvedula L, Jha AK. Fetomaternal outcome of scarred uterine rupture compared with primary uterine rupture: a retrospective cohort study. J Perinat Med 2023; 51:1067-1073. [PMID: 37125850 DOI: 10.1515/jpm-2023-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Literature comparing maternal and perinatal outcomes among women with scarred and primary uterine rupture are limited. Therefore, the study aimed to compare maternal and perinatal outcomes and associated risk factors of uterine rupture among scarred and unscarred uterus. METHODS This retrospective cohort study was performed at a large tertiary care of India between July 1, 2011 and June 30, 2020. We analysed all the cases of complete uterine rupture beyond the 20th week of gestation. The outcome measures were live birth rate, perinatal mortality, maternal mortality and morbidity. RESULTS A total of 115 complete uterine ruptures were noted in 148,102 pregnancies. Of those 115 uterine ruptures, 89 (77.3 %) uterine ruptures occurred in women with a history of caesarean delivery, and 26 (22.6 %) uterine ruptures occurred in primary uterine rupture. The primary uterine rupture group had a significantly higher incidence of lower parity, breech presentation and mean birth weight. The live birth rate (68.18% vs. 42.85 %; p=0.04) was significantly higher in the scarred group, and the stillbirth rate (57.14% vs. 31.86 %; p=0.009) was significantly higher in the primary uterine rupture group. Hypoxic ischemic encephalopathy, APGAR score, and neonatal intensive care unit admission were comparable. Postpartum haemorrhage, blood transfusion, severe acute maternal morbidity and intensive care unit stay were more frequently reported in the primary uterine rupture group. CONCLUSIONS The maternal and perinatal outcomes appear less favourable among women with primary uterine rupture than scarred uterine rupture.
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Affiliation(s)
- Makkam S Madhuri
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Nivedita Jha
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Veena Pampapati
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Latha Chaturvedula
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Ajay Kumar Jha
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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Hussein AI, Omar AA, Hassan HA, Kassim MM, Yusuf AA, Osman AA. Spontaneous Rupture of Unscarred Uterus in a Term Primagravida with Lethal Skeletal Dysplasia Fetus (Thanatophoric dysplasia). A Case Report and Review of the Literature. Int Med Case Rep J 2022; 15:551-556. [PMID: 36225974 PMCID: PMC9549793 DOI: 10.2147/imcrj.s383195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Background and Importance Spontaneous uterine rupture, especially in an unscarred uterus, is a rare pregnancy complication that can cause severe morbidity and mortality in both the mother and the fetus. The vast majority of uterine ruptures occur in the presence of a previous uterine scar, most commonly from a previous cesarean delivery. To our knowledge, here we reported the first case of spontaneous rupture of unscarred uterus in a term primigravida secondary to lethal skeletal dysplasia fetus (Type 1 Thanatophoric dysplasia) faced by a practicing clinician in an underdeveloped country (Somalia) with a successful outcome. Case Presentation The patient was 24 yrs. Old Primagravida, at 40 weeks gestation by LMP, presented with abdominal pain and active vaginal bleeding; she did not receive antenatal care during pregnancy; after initial abdominal ultrasonography and vaginal examination, laparotomy was performed due to high suspicion of uterine rupture. After dead fresh fetal extraction, the uterine defect was repaired successfully, and the patient was discharged home in good condition after several days. Conclusion Through this case, we would like to highlight the urgent need to focus on and recognize the importance of receiving antenatal care in the community so that the burden of thousands of lives lost each year can be reduced.
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Affiliation(s)
- Ahmed Issak Hussein
- Obstetrics and Gynecology Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia,Correspondence: Ahmed Issak Hussein, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia, Tel +252615597479, Email
| | - Abdikarim Ali Omar
- Obstetrics and Gynecology Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Hodan Abdi Hassan
- Obstetrics and Gynecology Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Mohamed Mukhtar Kassim
- Pediatric Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | | | - Ahmed Adam Osman
- Radiology Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
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Uleanya O, McCallin K, Khanem N, Sabir S. Recurrent uterine rupture in third trimester of pregnancy. BMJ Case Rep 2021; 14:e241987. [PMID: 34389587 PMCID: PMC8365815 DOI: 10.1136/bcr-2021-241987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/04/2022] Open
Abstract
We report a case of recurrent upper segment uterine rupture in a 31-year-old woman at 32+5/40 weeks of gestation. She had fundal uterine rupture 3 years ago in her first pregnancy at 40 weeks of gestation. There was no history of uterine malformation or prior uterine surgery. However, we noted that she had had three laparoscopic procedures for endometriosis treatment. She was scheduled to have an elective repeat caesarean section at 34+6/40 weeks of gestation in the index pregnancy. Unfortunately, she presented at 32+5/40 weeks with features of acute abdomen and signs of fetal distress. She had a category 1 caesarean section and was found to have fundal uterine rupture at the same site. She had a smooth uneventful recovery following a timely intervention and discharged home on day 5 postoperatively in a good condition with her baby girl.
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Affiliation(s)
- Obiefula Uleanya
- Department of Obstetrics and Gynaecology, Barnsley District General Hospital, Barnsley, UK
| | - Kate McCallin
- Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Noor Khanem
- Department of Obstetrics and Gynaecology, Barnsley District General Hospital, Barnsley, UK
| | - Sabahat Sabir
- Department of Obstetrics and Gynaecology, Barnsley District General Hospital, Barnsley, UK
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Tan SQ, Chen LH, Muhd Abdul Qadir D, Chern BSM, Yeo GSH. Risk factors and outcomes of uterine rupture in Singapore: Emerging trends. ANNALS ACADEMY OF MEDICINE SINGAPORE 2021. [DOI: 10.47102/annals-acadmedsg.2020319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ABSTRACT
Introduction: Uterine rupture is uncommon but has catastrophic implications on the pregnancy. A scarred
uterus and abnormal placentation are known contributory factors. The aim of our study was to review
the contributing factors, clinical presentation, complications and management of uterine rupture in our
population in light of the changing nature of modern obstetric practices.
Methods: A retrospective observational study was conducted at KK Women’s and Children’s Hospital
by studying proven cases of uterine rupture in the period between January 2003 and December 2014. These
cases were analysed according to their past history, clinical presentation, complications, management
and outcome.
Results: A total of 48 cases of proven uterine rupture were identified. The incidence of uterine rupture
was 1 in 3,062 deliveries. The ratio of scarred uterus rupture to unscarred uterus rupture was approximately
3:1. The most common factor was previous lower segment caesarean section for the scarred group, followed
by a history of laparoscopic myomectomy. Abdominal pain was the common clinical presentation in the
antenatal period, while abnormal cardiotocography findings were the most common presentation in
intrapartum rupture.
Conclusion: There is a notable shift in the trend of uterine rupture cases given the increasing use of
laparoscopic myomectomy and elective caesarean sections. While ruptures from these cases were few, their
presentation in the antenatal period calls for diligent monitoring with informed patient involvement in their
pregnancy care.
Keywords: Antenatal, laparoscopic myomectomy, birth after caesarean, rupture, VBAC
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Affiliation(s)
- Shu Qi Tan
- KK Women’s and Children’s Hospital, Singapore
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Mengesha MB, Weldegeorges DA, Hailesilassie Y, Werid WM, Weldemariam MG, Welay FT, Gebremeskel SG, Gebrehiwot BG, Hidru HD, Teame H, Gebremedhin H, Assefa NE. Determinants of Uterine Rupture and Its Management Outcomes among Mothers Who Gave Birth at Public Hospitals of Tigrai, North Ethiopia: An Unmatched Case Control Study. J Pregnancy 2020; 2020:8878037. [PMID: 33194231 PMCID: PMC7641719 DOI: 10.1155/2020/8878037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Uterine rupture is a leading cause of maternal death in Ethiopia. Despite strengthening the health care system and providing basic and comprehensive emergency obstetric care closer to the communities, uterine rupture continues to produce devastating maternal and fetal outcomes. Although risk factors of uterine rupture are context specific, there is lack of clarity in our context towards the contributing factors and untoward outcomes of uterine rupture. This study was conducted to identify the risk factors of uterine rupture and its impacts in public hospitals of Tigrai. OBJECTIVE This study would identify determinant factors of uterine rupture and its management outcomes among mothers who gave birth in public hospitals in Tigrai region, North Ethiopia. METHOD A retrospective hospital-based unmatched case control study design was implemented with 135 cases of women with uterine rupture and 270 controls of women without uterine rupture. Cases were enrolled consecutively from case notes of women who gave birth from 1/9/2015 to 30/6/2019, while charts (case note) of women without uterine rupture found following the cases were selected randomly and enrolled. Bivariate and multivariate logistic regression with 95% confidence interval was used to identify the determinants of uterine rupture. RESULT Mothers referred from remote health institutions (AOR 7.29 (95% CI: 2.7, 19.68)), mothers who visited once for antenatal care (AOR 2.85 (95% CI: 1.02, 7.94)), those experiencing obstructed labor (AOR 13.33 (95% CI: 4.23, 42.05)), and birth weight of a newborn greater than four kilograms (AOR 5.68 (95% CI: 1.39, 23.2)) were significantly associated with uterine rupture. From 135 mothers who develop uterine rupture, 13 (9.6%) mothers died and 101 (74.8%) fetuses were stillborn. Obstetrical complications like abdominal hysterectomy in 75 (55.6%) of mothers and excessive blood loss in 84 (57.8%) were additional untoward outcomes of uterine rupture. CONCLUSION Referrals from remote health institutions, once-visited antenatal care, obstructed labor, and birth weight of newborns greater than four kilograms were significant determinants of uterine rupture. Maternal death, stillbirth, hysterectomy, and hemorrhage were adverse outcomes. The findings of this study suggest early identification of factors that expose to uterine rupture during antenatal care, labor, and delivery must be attended to and further prospective studies are needed to explore predictors of untoward outcomes. Knowing the determinants of uterine rupture helps prevent the occurrence of a problem in pregnant women, which reduces maternal morbidity and mortality, and would have a tremendous help in identifying the best optional strategies in our current practices. This assertion was added to the abstract concluding session.
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Affiliation(s)
- Meresa Berwo Mengesha
- Department of Midwifery, Adigrat University, College of Medicine and Health Sciences, Adigrat, Tigrai, Ethiopia P.O. Box No. 50
| | - Desta Abraha Weldegeorges
- Department of Midwifery, Adigrat University, College of Medicine and Health Sciences, Adigrat, Tigrai, Ethiopia P.O. Box No. 50
| | - Yared Hailesilassie
- Department of Nursing, Adigrat University College of Medicine and Health Sciences, Adigrat, Tigrai, Ethiopia
| | - Weldu Mammo Werid
- Department of Midwifery, Adigrat University, College of Medicine and Health Sciences, Adigrat, Tigrai, Ethiopia P.O. Box No. 50
| | - Mulu Gebretsadik Weldemariam
- Department of Midwifery, Adigrat University, College of Medicine and Health Sciences, Adigrat, Tigrai, Ethiopia P.O. Box No. 50
| | - Fissaha Tekulu Welay
- Department of Midwifery, Adigrat University, College of Medicine and Health Sciences, Adigrat, Tigrai, Ethiopia P.O. Box No. 50
| | - Senait Gebreslasie Gebremeskel
- Department of Midwifery, Adigrat University, College of Medicine and Health Sciences, Adigrat, Tigrai, Ethiopia P.O. Box No. 50
| | | | - Hagos Degefa Hidru
- Department of Public Health, Adigrat University College of Medicine and Health Sciences, Adigrat, Tigrai, Ethiopia
| | - Hirut Teame
- Department of Public Health, Adigrat University College of Medicine and Health Sciences, Adigrat, Tigrai, Ethiopia
| | - Haftay Gebremedhin
- Department of Public Health, Adigrat University College of Medicine and Health Sciences, Adigrat, Tigrai, Ethiopia
| | - Natnael Etsay Assefa
- Department of Midwifery, Adigrat University, College of Medicine and Health Sciences, Adigrat, Tigrai, Ethiopia P.O. Box No. 50
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Kim JS, Ha J, Kim WY. Uterine rupture with intact amniotic membrane. Emerg Med Australas 2018; 31:141-142. [PMID: 30582288 DOI: 10.1111/1742-6723.13221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/11/2018] [Accepted: 08/16/2018] [Indexed: 11/27/2022]
Affiliation(s)
- June-Sung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jiyeon Ha
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Ahmed DM, Mengistu TS, Endalamaw AG. Incidence and factors associated with outcomes of uterine rupture among women delivered at Felegehiwot referral hospital, Bahir Dar, Ethiopia: cross sectional study. BMC Pregnancy Childbirth 2018; 18:447. [PMID: 30445936 PMCID: PMC6240227 DOI: 10.1186/s12884-018-2083-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 11/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background Maternal mortality is a major public health challenge in Ethiopia. Uterine rupture is an obstetrical emergency with serious undesired complications for laboring mothers resulting in fatal maternal and neonatal outcomes. Uterine rupture has been contributing to high maternal morbidity and mortality. However, there is limited research on the factors and management outcomes of women with uterine rupture. Understanding the factors and management outcomes might delineate strategies to support survivors. Therefore the aim of this study is to assess the incidence and factors associated with outcomes of uterine rupture among laboring mothers at Felegehiwot Referral Hospital in Bahir Dar City, Northwest Ethiopia. Methods This is a cross sectional study with retrospective facility based data collection technique. All pregnant women who were managed for ruptured uterus at Felegehiwot referral hospital from September 11 2012 to August 30 2017 were included. The chart numbers of the women collected from operation theatre registers. Their case folders retrieved from the medical records room for analysis. Using structured check list, information on their sociodemography, booking status, clinical features at presentation and the place of attempted vaginal delivery was extracted. Data on the intraoperative findings, treatment, and associated complications and outcomes also collected. The collected data cleaned, coded and entered into EPI- Info version (7.1.2.0) and then exported in to SPSS Version 20.0 for analysis. Statistical comparison was done using chi square (X2). Strength of association between the explanatory variables and outcome variables described using odds ratio at 95% CI and P value less than 0.05. The results presented in tables. Results We studied 239 cases of uterine rupture in the 5 years period. Mothers without previous cesarean delivery including eight primigravidas took 87% of the cases. From all study participants, 54 of mothers (22.6%) developed undesired outcomes whereas 185(77.4%) discharged without major sequel. More than half (56.9%) arrived in hypovolemic shock. Total abdominal hysterectomy was the commonest procedure accounting for 61.5%. Duration of surgery was less than 2 h in 67.8% of the procedures. Anemia is the commonest complication (80.3%) followed by wound infection and VVF (11.7% each). There were 5 maternal deaths (2.1%). Mothers who had prolonged operation time (> 2 h) (AOR: 2.2, 95% CI: 1.10, 4.63) were significantly associated with undesired maternal outcomes after management of uterine rupture. Conclusion Incidence of ruptured uterus and its complications were high in the study area. It reflects the need for improvement in obstetric care and strong collaboration with referring health facilities to ensure prompt referral and management.
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Affiliation(s)
- Dawud Muhammed Ahmed
- Obstetrics and Gynecology, Bahir Dar University, College of Medicine and Health Sciences, P. O box: 79, Bahir Dar, Ethiopia.
| | - Tesfaye Setegn Mengistu
- Bahir Dar University College of Medicine and Health Sciences, Bahir Dar, Amhara Regional State, Ethiopia
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Milazzo GN, Catalano A, Badia V, Mallozzi M, Caserta D. Myoma and myomectomy: Poor evidence concern in pregnancy. J Obstet Gynaecol Res 2017; 43:1789-1804. [PMID: 28892210 DOI: 10.1111/jog.13437] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/21/2017] [Accepted: 05/28/2017] [Indexed: 02/02/2023]
Abstract
AIM Summarize the results of the many, but often underpowered, studies on pregnancy complicated by myoma or myomectomy. METHODS Survey of the electronic PubMed database for the last two decades was conducted. We selected reviews, meta-analyses, case series, case reports, clinical studies only with statistical analysis, and guidelines from scientific societies. RESULTS Delaying childbearing leads to an increased incidence of pregnancy complicated by fibroids or previous myomectomy. Approximately 10-30% of pregnant women with myomas develop complications during gestation, at delivery and in puerperium. Submucosal, retroplacental, large and multiple myomas have a greater risk of complications. Cervical myomas, although rare, need careful management. The location and size of the fibroids should be assessed from the first trimester. Despite the increased risk of cesarean section, fibroids are not a contraindication to labor, unless they obstruct the birth canal or other obstetric conditions coexist. Myomectomy during pregnancy, in selected cases, is feasible and safe. Myomectomy cannot be considered a prophylactic measure prior to conception, but has to be individualized. Uterine rupture after myomectomy generally occurs in the third trimester or during labor and some associated risk factors have been identified. There is no consensus on the optimal interval between myomectomy and conception. CONCLUSIONS Pregnancy in patients with fibroids or previous myomectomy should be considered as high risk, requiring a maternal-fetal medicine specialist. To date available literature is inconsistent on evidence-based management. Further research is needed for definitive recommendations.
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Affiliation(s)
- Giusi Natalia Milazzo
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Angelica Catalano
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Valentina Badia
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Maddalena Mallozzi
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Donatella Caserta
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
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Astatikie G, Limenih MA, Kebede M. Maternal and fetal outcomes of uterine rupture and factors associated with maternal death secondary to uterine rupture. BMC Pregnancy Childbirth 2017; 17:117. [PMID: 28403833 PMCID: PMC5389173 DOI: 10.1186/s12884-017-1302-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 04/07/2017] [Indexed: 12/17/2022] Open
Abstract
Background Maternal mortality and morbidity are the priority agenda for sub-Saharan Africa including Ethiopia. Uterine rupture is the leading cause of maternal and fetal death in developing countries. Limited evidence is available on the magnitude of uterine rupture; maternal and fetal outcomes of uterine rupture and factors associated with maternal death secondary to uterine rupture in Ethiopia. This study aimed to assess the magnitude of uterine rupture; maternal and fetal outcome of uterine rupture and factors associated with maternal death secondary to uterine rupture in Debremarkos Referral Hospital, Northwest Ethiopia. Methods An institutional-based cross-sectional study was conducted in December 2015 in Debremarkos referral hospital, Northwest Ethiopia. A total of 242 records of mothers with uterine rupture at Debremarkos referral Hospital during the year 2011–2014 were included in the study. Secondary data was collected from the records of mothers admitted for the management of uterine rupture. Descriptive statistics were performed to characterize the study population. Bivariate and multivariable logistic regression model was fitted to identify factors associated with maternal death secondary to uterine rupture. Odds ratio with 95% confidence interval was computed to determine the level of significance. Results A total of 10,379 deliveries were attended A total of 242 uterine rupture cases were included in this study. The magnitude of uterine rupture was 2.44% (1 in 41 deliveries). Sixteen (6.6%) mothers died from uterine rupture. Fourteen (5.8%) had experienced Vesico Vaginal Fistula. The majority of the mothers, 72% (176), admitted for uterine rupture stayed in hospital for 6–10 days. Fetal outcome was grave, 98.3% (238) were stillborn. Place of labor [Adjusted odds ratio (AOR): 6.92, 95% confidence interval (CI): (1.16, 33.74)], occurrence of hypo volume shock [AOR: 3.48, 95% CI: (1.01, 11.96)] and postoperative severe anemia [AOR: 0.092, 95% CI: (0.01, 0.956)] were significantly associated with maternal death secondary to uterine rupture. Conclusion The magnitude of uterine rupture was high in the study area. Initiation of labor at health institutions, early treatment of hypo-volumia and prevention of postoperative anemia is recommended to decrease maternal death secondary to uterine rupture.
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Affiliation(s)
- Geremew Astatikie
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Miteku Andualem Limenih
- Department of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mihiretu Kebede
- Institute of Public Health, Department of Health Informatics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. .,Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
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Mourad WS, Bersano DJ, Greenspan PB, Harper DM. Spontaneous rupture of unscarred uterus in a primigravida with preterm prelabour rupture of membranes. BMJ Case Rep 2015; 2015:bcr-2014-207321. [PMID: 26055584 DOI: 10.1136/bcr-2014-207321] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intrapartum uterine rupture is a true obstetrical emergency. Uterine rupture is associated with severe maternal and fetal morbidity and mortality. It is rare in the unscarred uterus of a primigravida. A 23-year-old primigravida with an unscarred uterus was admitted with preterm prelabour rupture of membranes at 36(+4) weeks of gestation. Abnormal fetal heart monitoring, associated with acute onset of severe abdominopelvic pain, developed on admission. Rupture occurred prior to onset of regular uterine contractions and in the absence of any interventional oxytocin. The neonate had evidence of severe acidosis despite emergency caesarean delivery. This case highlights the importance of maintaining a high index of suspicion for uterine rupture, even in the unlikely setting of a primigravida with an unscarred uterus.
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Affiliation(s)
- Wael Sayed Mourad
- Department of Community and Family Medicine, Obstetrics Fellowship Division and Family Medicine Residency Program, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Debbra J Bersano
- Department of Obstetrics and Gynecology, Truman Medical Center Lakewood, Kansas City, Missouri, USA
| | - Peter B Greenspan
- Department of Obstetrics and Gynecology, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Diane Medved Harper
- Department of Family and Geriatric Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Senturk MB, Cakmak Y, Guraslan H, Dogan K. Emergency peripartum hysterectomy: 2-year experiences in non-tertiary center. Arch Gynecol Obstet 2015; 292:1019-25. [PMID: 25929233 DOI: 10.1007/s00404-015-3740-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 04/24/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to evaluate risk factors, indications and materno-fetal outcomes for emergency peripartum hysterectomy. METHODS Retrospective evaluation was made of 23 cases. Maternal and neonatal outcomes, need for referral to the tertiary center and related complications were compared to those at the initial diagnosis for surgery, location of delivery, type of surgery and the admission diagnosis. The risk factors associated with emergency peripartum hysterectomy were also investigated. Significance was evaluated at p values of <0.01 and <0.05. RESULTS There was a correlation between peripartum hysterectomy and uterine atony or uterine rupture (p < 0.01). The referral rates of patients with home delivery were significantly higher than those of patients who delivered in hospital (p = 0.02) but no significant difference was observed in the neonatal outcomes (p = 0.38). There was no significant difference in the rates of maternal complications between home and hospital delivery (p = 0.068). According to the indication for surgery, no significant difference was observed between the rates of referral to the tertiary center, maternal outcomes, complications, or need for maternal intensive care (p > 0.05). However, a highly significant difference was observed between the neonatal outcomes (p = 0.001). CONCLUSION The results of this study showed the most important risk factors associated with peripartum hysterectomy to be uterine atony, grand multiparity, and uterine rupture. Maternal intensive care, maternal death, neonatal death, or neonatal intensive care were associated with home delivery or delayed presentation at hospital.
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Affiliation(s)
- Mehmet B Senturk
- Departments of Obstetrics and Gynecology, Bakirkoy Dr Sadi Konuk Teaching and Research Hospital, Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, 34147, Istanbul, Turkey.
| | - Yusuf Cakmak
- Department of Obstetrics and Gynecology, Batman State Hospital, Batman, Turkey
| | - Hakan Guraslan
- Departments of Obstetrics and Gynecology, Bakirkoy Dr Sadi Konuk Teaching and Research Hospital, Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, 34147, Istanbul, Turkey
| | - Keziban Dogan
- Departments of Obstetrics and Gynecology, Bakirkoy Dr Sadi Konuk Teaching and Research Hospital, Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, 34147, Istanbul, Turkey
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