Rupture of left horn of bicornuate uterus at twenty weeks of gestation.

Rupture uterus in nulliparous patients is generally associated with mullerian anomalies. A case of 23 years primigravida with 19 weeks gestation presenting with features of rupture is reported here. Ultrasound helped in the diagnosis of left horn of bicornuate uterus. After exploration, right ruptured horn was excised. The incidence, diagnosis and management of such cases is discussed.

Obstetric hazards among elderly primigravidae.

Three hundred and seventeen cases of elderly primigravidae were studied from January 1987 to December 1990 at Lokmanya Tilak Municipal General Hospital, Bombay. The aim was to study the complications of pregnancy, complications of labour, perinatal mortality and maternal mortality in an urban, socio-economic backward class of elderly primigravidae and to compare them with younger primigravidae in the same population. The study covered all cases, either booked for hospital confinement or admitted as an emergency case without any prior antenatal care. The incidence of breech was found to be higher in elderly primiparae as compared to younger primiparae. Duration of labour as also operative intervention was found to be more in elderly primigravidae. There was no maternal mortality in this study. The most important feature in relation to infants was the high perinatal mortality in the study group.

Reproductive performance following Shirodkar's abdominal sling operation.

Over a period of 4 years from January 1986 to December 1989, 79 cases in whom Shirodkar's abdominal sling operation carried out, were studied. All the patients were admitted either in active labour or as cases of abortions or for the treatment of infertility. The incidence of full term normal vaginal delivery in this study was 69.56% and the incidence of caesarean section was only 2.9%. There was one case of posterior wall rupture following previous Shirodkar's sling operation. The recurrence rate of prolapse was only 8.69%.

Rupture uterus: changing trends in etiology and management.

Sixty-four cases of rupture uterus which occurred during the period 1980-89 were studied and compared with 70 cases in the preceding decade (1970-79). The changing trends in etiological factors and management of this condition have been demonstrated. While spontaneous rupture continued to account for about two-thirds of the cases (70.3%), the incidence of traumatic rupture uterus has become less than half, from 17.1 to 7.8%, and that of scar rupture has increased to more than double (from 11.4 to 23.4%). As regards management, there are improved results seen with conservative repair of the uterus. It was also seen that a subtotal hysterectomy was more commonly resorted to than total hysterectomy in the later decade. There was a decrease in the overall morbidity from 42.8 to 35.9% and also in the mortality rate from 24.3 to 18.7%.