Intrapartum rupture of the gravid uterus

ABSTRACT

To review all cases of intrapartum rupture of the gravid uterus that occurred at the Riyadh Armed Forces Hospital between 1986 and 1997, determine its incidence, analyse the contributing factors and outline measures of prevention. Retrospective case record analysis of 31 cases of diagnosed intrapartum uterine rupture. During the study period, there were 75,398 deliveries conducted and 31 cases of intrapartum rupture of gravid uterus reported. Nine [29%] occurred in unscarred uterus [17849]. Two had failed attempt at ventouse/forceps delivery. Eight [88.8%] patients received blood transfusion. The Perinatal mortality rate was 55.5%. Of the 22 cases of ruptured scarred uterus, 18 had one previous cesarean operation. Four [18%] were ventouse deliveries. The fetal mortality rate was 9%. Only 13 [59%] patients received blood transfusion. Repair of uterine rupture was carried out in all 31 cases. There were no maternal deaths. There was significantly higher blood loss [2344ml vs 1036, P<0.0001], Perinatal loss [55.5% vs 9%, P<0.01], age [34 years vs 29 years, P<0.001] and parity [5 vs 3, P<0.001], in the unscarred group as compared to the scarred one. The incidence of ruptured uterus was 0.04%. The main contributing factors identified were scarring from previous cesarean section, misjudgment of operative vaginal delivery, and failure to recognise early signs of impending uterine rupture. Close monitoring of uterine contraction, fetal heart tracing and exclusion of cephalopelvic disproportion before attempting operative vaginal delivery will help in reducing the incidence of uterine rupture to a minimum