Uterine rupture: a revisit

Case of Cornual Uterine Rupture in Subsequent Pregnancy Following Laparoscopic Removal of Cornual Ectopic Pregnancy

Uterine rupture during pregnancy is a critical obstetric complication associated with maternal and fetal mortality and morbidity. We present a case of uterine rupture at 27 weeks of gestation, following a previous cornual pregnancy managed laparoscopically. Our case report underlines the importance of multilayered uterine wall repair following the resection of cornual ectopic pregnancy to avoid such potentially catastrophic sequelae.

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.

Survival Status and Predictors of Mortality Among Women with Uterine Rupture at Public Hospitals of Eastern Ethiopia. Semi-Parametric Survival Analysis

Background

Uterine rupture is the most dangerous complication of labor and contributes to high maternal mortality. Despite efforts to improve basic and comprehensive emergency obstetric treatment, women continue to suffer from disastrous maternal outcomes.

Purpose

This study aimed to assess the survival status and predictors of mortality among women with uterine rupture at public hospitals in the Harari Region, Eastern Ethiopia.

Patients and Methods

We conducted a retrospective cohort study among women with uterine rupture in public hospitals in Eastern Ethiopia. All women with uterine rupture were followed for 11 years retrospectively. Statistical analysis was conducted with STATA version 14.2. Kaplan-Meier curves together with a Log rank test were used to estimate the survival time and show the presence of differences among groups. Cox Proportion Hazard (CPH) model was used to determine the association between independent variables and survival status.

Results

There were 57,006 deliveries in the study period. We found that 10.5% (95% CI: 6.8-15.7) of women with uterine rupture have died. The median recovery and death time for women with uterine rupture were 8 and 3 days with interquartile range (IQR) of 7-11 days and 2-5 days, respectively. Antenatal care follow-up (AHR: 4.2, 95% CI: 1.8-9.79), education status (AHR: 0.11; 95% CI: 0.02-0.85), visiting health center (AHR: 4.89; 95% CI: 1.05-22.88), and admission time (AHR: 4.4; 95% CI: 1.89-10.18) were the predictors of survival status of women with uterine rupture.

Conclusion

One out of ten study participants died due to uterine rupture. Factors including not having ANC follow-up, visiting health centers for treatment, and being admitted during the night time were predictors. Thus, a great emphasis has to be given to the prevention of uterine rupture and the linkage within health institutions has to be smooth to improve the survival of patients with uterine rupture with the help of different professionals, health institutions, health bureaus, and policymakers.