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Objective: To identify the comparative obstetric risk factors, management modalities, and the associated maternal and perinatal morbidity and mortality of ruptured uterus between scarred uterus versus unscarred uterus at a tertiary care hospital.
Materials and methods: A two year retrospective analysis of 77 cases of uterine rupture was carried out. The charts of these patients were analyzed and the data regarding risk factors, management, maternal and foetal morbidity and mortality was studied.
Results: The majority of patients had prior lower segment transverse cesarean section. The clinical presentation of the patients with rupture of the unscarred uterus was more dramatic and challenging with extensive tears compared to rupture with scarred uterus. Most of the patients were not taking any antenatal care. The patients with rupture of the unscarred uterus had more blood loss, necessity of subtotal hysterectomies and perinatal deaths. There were three maternal deaths, two in unscarred uterus group and one in scarred uterus group.
Conclusions: Uterine rupture is a major contributor to maternal morbidity and neonatal mortality but it is higher among unscarred uterus group. Maternal mortality doesn't have statistically significant difference in both groups. Four major easily identifiable risk factors including history of prior caesarean section, grand multiparity, obstructed labour, and foetal malpresentations constitute majority of the cases of uterine rupture. Regular antenatal care, identification of these high risk factors, early diagnosis, and optimal management needs to be overemphasized to avoid foetomaternal complications.
Keywords: Antenatal care; Blood transfusion; Hysterectomy; Maternal mortality; Perinatal mortality