UTERINE RUPTURE: A THREE-YEAR RETROSPECTIVE REVIEW AT A TERTIARY CARE HOSPITAL IN UDAIPUR, RAJASTHAN, INDIA

Abstract

Background: Uterine rupture (UR) is one of the most devastating event occurring in the life me of a women. It leads to a high rate of both maternal and perinatal morbidity and mortality.

Objective: The present study was aimed to know the incidence of uterine rupture among pregnant women along with its associated risk factors like age, parity, preceding events leading to rupture, clinical presentation, modality of management, intra- operative findings, postoperative complications, maternal and perinatal status in one of the largest tertiary care hospitals in Rajasthan.

Materials and methods: A three-year retrospective analysis of uterine rupture cases was done from 2017 to 2019. The case sheets of 75 patients were collected and the data regarding referral area, age, parity, condition at me of admission and discharge, preceding events leading to rupture, clinical presentation, modality of management, intra-operative findings, postoperative complications, maternal and perinatal status was studied.

Results: In this retrospective study from the year of 2017-2019, the incidence of uterine rupture was found to be 0.13% in which 96% of the cases belonged to rural community with maximum referral from Dungarpur Community Health Centre. The incidence of scarred and unscarred uterus was found to be comparable i.e. equal to about 50%. The rupture was more common among second gravid as, with an interpregnancy interval of 2-4 years. The most common cause was scarred uterine rupture with silent rupture, followed by failure of trial of labour after caesarean section (TOLAC). Most common cause noticed in unscarred uterus was multiparity with spontaneous labour due to malpresentation. Majority of the cases experienced uterine rupture in the gestational age of 34-40 weeks, mainly in the intrapartum period. With respect to intraoperative findings the lower and anterior segment of uterus was involved with hemoperitoneum being the most common associated complication. Most of the cases (55%) were repaired depending on the general condition and rupture status of the patient. In the present study, the most common postoperative complication was urinary tract infection. The overall incidence of perinatal and maternal mortality due to UR was found to be 2.49% and 3.7% respectively.

Conclusion: Uterine rupture although being preventable is one of the most leading cause of maternal and perinatal mortality in developing nations. A proper antenatal and intrapartum care would definitely decrease the incidence of uterine rupture. Therefore, identification of these high risk women with immediate diagnosis, proper referral and primary management can further save the lives of many mothers in India. Altogether, this can only be achieved with proper primary education with awareness among woman.

Keywords: Caesarean section; Hysterectomy; Obstructed labour; Perinatal outcome; Rupture of gravid uterus; Uterine rupture