Rupture of the Gravid Uterus: A Review of 92 Cases

Objectives: The aim of this study was to evaluate the incidence of ruptured uterus at a tertiary-care referral unit in India and to identify the major etiological factors, uterus rupture management, and feto-maternal outcome. Design: This was a retrospective analysis of hospital records. Methods: A 10-year retrospective study was carried out, and a total of 92 cases of ruptured uterus were included and evaluated. Results: The incidence of ruptured uterus was 1: 705 deliveries; 95.5% were multipara and 86% of patients were not booked. The majority of cases (57.60%) of ruptured uterus occurred in patients with scarred uteri. Causes of rupture were: use of oxytocics, 54.35%; prolonged/obstructed labor, 27.17%; cephalopelvic disproportion, 22.83%; grand multiparity, 17.39%; malpresentations, 13.04%; instrumental deliveries, 5.43%; rudimentary horn pregnancy, 2.17%; and trauma 2.17%. Five (5) cases had associated bladder injury. The site of rupture was in the lower uterine segment in 70.65% of cases, followed by left lateral rupture in 13.04% of cases. Rent repair was done in 77.17% of cases, total/subtotal hysterectomy in 17.39% of cases, and excision of rudimentary horn in 2.17% of cases. There were 11 maternal deaths (11.95% of cases) and perinatal mortality was 86% of cases. Conclusions: Rupture of the gravid uterus is a grave obstetric complication associated with high maternal and perinatal mortality. Health education of women regarding contraception and family planning, antenatal care, training and supervision of traditional birth attendants, timely referral, and availability of transport are some of the measures that can be taken to reduce the incidence of uterine rupture in resource poor settings.