Rupture uterus: Carelessness or negligence.

Uterus is the most unique reproductive organ in humans. Rupture uterus is a hazardous complication of pregnancy and labour, and carries high risk both to the mother and the foetus. Uterine rupture during third trimester of pregnancy is a rare complication but if there is rupture and not suspect with in time may have fatal out come for the mother, foetus or both. In this modern medical era, prenatal check-up, advanced non invasive diagnostic facilities and subsequent treatment does not produce such life threatening complication. Rupture uterus cases are observed due to either carelessness of the patient or negligence of the doctor. Three cases of rupture uterus are discussed in this paper of full term pregnancy, had complete antenatal visits with all investigations including ultrasonography and attended the hospital well in time before death. Most cases of rupture uterus are preventable with good ante-natal and intra-partum care, and proper identification of high-risk cases.

Ruptured uterus; an ongoing tragedyof motherhood

To analyze the risk factors for uterine rupture and to share the 5 years experience of ruptured uterus with other colleagues of the specialty. Case series descriptive study. Gynae/Obstetrics Unit-I Lady Willingdon Hospital Lahore. Five years i.e 1st May 2004 to 30th April 2009. Obstetric patients who presented with ruptured uteri. Results showed that risk factor for ruptured uteri include cesarean sections [61.11%], grand multiparty [16.6%], Instrumental deliveries [4.44%] and undetected perforation [1.11%]. Ruptured uterus is a high risk category of patients. The patients with previous scar, grand multiparas, obstructed prolonged labour must be managed by proper trained personnel and in tertiary care centers in order to avoid the morbidity or mortality due to ruptured uterus

Uterine rupture in Dohuk, Iraq

Rupture of the uterus is a serious obstetric emergency endangering the life of both mother and fetus. In a study at the general hospital in Dohuk, Iraq, from January 2003 to December 2004, the incidence of ruptured uterus was 0.2% [42 out of 20 574 deliveries]. The majority of these women [81%] were unbooked and had had no antenatal care. The range of parity was 1-13, median 7. The main causes were obstructed labour and previous caesarean scar [36% of cases each]. The maternal mortality rate among these cases was 5% and the perinatal mortality rate was 62%. Improvements are needed in antenatal care and labour guidelines and emergency drill training for staff

Rupture uterus in primigravida: morbidity and mortality.

OBJECTIVE: This paper is aimed to present "Rupture of the uterus (RU) in primigravida "- unscarred cases which are supposed to be extremely rare. MATERIAL AND METHOD: The charts of patients labelled as "Rupture Uterus" for the period 1985 - 2005 AD (2042 - 2061 BS), 20 years were taken out and analysed. RESULT: There were 251 cases of rupture uterus during the study period giving the incidence of 0.09% i.e. 1:1100 among live births in a very busy tertiary maternity hospital of capital, Kathmandu of Nepal. There were 60% spontaneous, 29% scar dehiscence and 11% Iatrogenic/traumatic rupture and death due to RU was 7.9%(n=20). Fifteen cases (6%) were primigravid patients -- six were young primi (age 19 and below) and 9 primigravid patients. Five cases were referred from the district hospitals. Ten cases were brought from very far off i.e. more than 50 KM from the city. One case presented at 34, one at 41 and all the others presented between 38 to 40 weeks of gestational age. Only three cases had attended ante-natal clinics. All were having labour pain for more than 48 hours at home. Findings of laparotomy: The lesions found were: ruptured bladder and complete lower segment (CLS) up to the cervix - 1, CLS & cervix -2, complete lower segment (CLS) 1, Complete upper segment (CUS) - 2, Complete upper & lower segment (CULS) - 6, (one had tear at posterior wall of the uterus and the other had tear up to posterior vaginal wall) and Incomplete lower segment (LS) 2. Blood grouping & Rh: six cases had O+, four had A+, four had AB+ and one had B positive. The blood transfusion given was 1 - 4 units. The treatment given was laparotomy and repair in 10; one had LUSCS, repair of bladder and cervical injury. One had repair and bilateral tubal-ligation, one had subtotal hysterectomy and another had hysterectomy & repair of posterior wall of vagina. Four cases were admitted in the state of shock among which 1 had irreversible shock and died before surgical intervention. Another died on the 3rd post-operative day due to convulsions and shock. Maternal mortality (MM) was 13% (2/15) in primips. All cases presented with intrauterine fetal death (IUFD) and had still births (one baby was hydrocephalic). The hospital stay varied from 3 - 170 days. Four cases had vesico-vaginal fistula (VVF) CONCLUSION: Rupture of uterus in primigravida though rare, has been common in developing countries with low socio-economic status.

Rupture of uterus at term

Analysis of 195 cases of ruptured uterus admitted in the department of Gynaecology and Obstetrics JInnah Postgraduate Medical Centre, Karachi was made over a period of live years from 1st January 1989 to 31 st December 1993. The total number of deliveries during this period was 35468 making the incidence of ruptured uterus 0.55% [1:182]. Out of these 195 cases 27 were booked while the rest were admitted in emergency. The most common cause was rupture of the previous caesarean section scar other causes being obstructed labour injudicious use of oxytocics and trauma. The maternal mortality in this series was 8.72% and foetal mortality 72.82%

Study of the maternal mortality in Egypt and at Ahmed Maher teaching hospital

Maternal mortality and morbidity is higher in Egypt than other countries in the world and in the area covered by Ahmed Maher Teaching Hospital is still high. The aim of this study is to discover the main factors of maternal mortality and trying to reduce the incidence of these factors especially the avoidable one

Ruptura del utero gravido en el Hospital General de Medellin: un estudio de 10 anos 1978-1987 / Gravid uterus rupture in Hospital General de Medellin: study of 10 years 1978-1987

Se realizo un estudio descriptivo, retrospectivo para evaluar la incidencia de ruptura uterina en el Hospital General de Medellin, en un periodo de 10 anos. Se presentaron 42 casos para una proporción acumulada de 1:4466 partos y una tasa de incidencia de 26.59 casos por 100.000 partos. Los 2 principales factores de riesgo fueron el antecedente de cicatriz uterina en el 50% de las pacientes y el uso de oxitocina exogena en el 30.9%. El 73.8% de las pacientes presento algunos de los factores de riesgo estudiados y entre las posibles causas, el trabajo de parto prolongado y la distocia mecanica, fueron las dos mas importantes en su orden. El tratamiento consistio en histerectomia total en le 47.6% e histerorrafia en una proporción igual de las pacientes. Dos pacientes (4.7%) fueron solamente observadas. Como tratamiento complementario se realizo hemotransfusion en el 73.8% de los casos. entre otros. No hubo muertes maternas; sin embargo, la mortalidad fetal fue de 64.2% y la perinatal del 69%. Solo el 27.5% de las muertes perinatales ocurrieron en el grupo de bajo peso (2.500 gr.) El 95% de los casos ocurrieron despues del inicio del trabajo de parto y el 4.7% ( dos casos) antes; ambos causados por acretismo placentario con perforación del peritoneo visceral

Rupture of uterus cases reports and review of literatures

25 consecutive cases of ruptured uterus were studied at maternity department-Yarmook Teaching Hospital. Causes, clinical features, parity and course of labor were discussed in relation to the rupture. Perinatal mortality was very high as expected, maternal mortality was rather low. The commonest cause was obstructed labor and malpresentation. Incidence of iatrogenic rupture was significantly high in cases referred from district hospitals