Predisposing Factors and Outcome in Patients with Ruptured Uterus

Abstract

Background: Uterine rupture is one of the major causes of antepartum as well as postpartum hemorrhage leading to significant
maternal and fetal morbidity and mortality.
Objective: Aim of this study was to evaluate risk factors, clinical presentation, management and maternal and fetal outcome in
patients with rupture uterus.
Material and Methods: A descriptive cross sectional study was conducted at Gynae B Unit, Mardan Medical Complex, Mardan. It
was a two year study from 1st January 2017 to 31st Dec 2018. Data included patients from outpatient department and emergency
admissions through casualty. All cases of intraoperative finding of ruptured uterus of any age and parity at gestation 28 weeks or
more were included in the study while patients with rupture due to trauma and ectopic pregnancies were excluded from the study.
Data was collected for clinical presentation, risk factors, surgical management , maternal and fetal outcome.
Results: The frequency of ruptured uterus was 18 per 10000 with incidence of 0.18 % in this institute. Mean age at presentation
was 33.27+2yrs and 59(80%) were multiparous. Unbooked women were 68(93%). Patients delivered at home by untrained
attendants were 60(62%) while 34(46%) were delivered by trained staff. The most common risk factor was oxytocin augmentation
33(45%) followed by previous scar in 22(30%). Patients presented with more than one symptoms in 27(37%) cases, followed by
vaginal bleeding in 19(26%) and abdominal pain 15(20%). 62(84%) Patients with uterine rupture in intrapartum period were
62(84%) cases. Surgical findings at laparotomy was complete rupture in 64(87%) patients while 9(12%) had incomplete rupture.
The commonest site of rupture was lower uterine segment in 41(56%) cases followed by rupture at previous scar in 13(17%) cases.
Surgical treatment was subtotal abdominal hysterectomy in 43(58%) cases followed by repair of rupture site in 27(36%). The most
common complication was anemia in 56(76%) cases. Maternal death occurred in 4(5%) patients. Fetal death occurred in 59(80%)
cases.
Conclusion: Uterine rupture is a serious obstetrical emergency increasing both maternal and fetal morbidity and mortality. It was
concluded from our study that oxytocin use and multiparty was the most common risk factor even in safe hands resulting in more
than 50 percent of the patients losing their future fertility.