Rupture uterus--changing Indian scenario.

A total of 60 cases of rupture uterus managed in last five years in the department of obstetrics and gynaecology at the University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi were reviewed. Of these 77% cases reported to the hospital with rupture uterus while in 23% cases rupture occurred after admission. The factor responsible for rupture in admitted patients was either oxytocin induction/augmentation in scarred uterus or obstetrical manipulation in unscarred uterus; 80% cases were totally unsupervised during antenatal period. Previous uterine scar was responsible for rupture in as high as 63.3% cases. The commonest previous surgery was caesarean section mostly for non-recurrent causes. Obstructed labour was responsible for rupture in 26.6% cases while traumatic rupture was seen in 10% cases. Repair of uterine rent was performed in 54% cases while rest required hysterectomy. Bladder injury was associated in 9 cases and was repaired at the time of laparotomy. Maternal mortality was 3.33% and foetal mortality was 78.66%. The changing trends observed in the present study are those of low maternal mortality and decreasing incidence of obstructed labour in the aetiology of rupture uterus.

Acute abdominal pain in gynaecology.

Fifty female patients with acute abdominal pain were studied. High risk factors helping in clinical diagnosis were evaluated and 7(14%) cases with clear cut surgical indications were immediately operated on while 43 (86%) were kept under active observation. In doubtful cases, culdoscopy and diagnostic laparoscopy were found to be helpful in confirming the diagnosis and another 26% were operated later on. The delay in surgery did not increase the morbidity and mortality and only one patient (2%) underwent unnecessary laparotomy. Hence, it was concluded that active observation in cases of acute abdominal pain of doubtful origin is a safe and effective approach.