Uterine Rupture: an audit to analyze management options, maternal & fetal outcome

Abstract

Study Design: An analysis of 14 cases of ruptured uterus was done during January 2003 to December 2003 in Obstetrics & Gynae Department of Lahore General Hospital, Lahore. Objective: The purpose of this Audit was to analyse the different management options, maternal and fetal outcome in uterine rupture. Material and Methods: Total no of births in 2003 was 4840. Total number of ruptured uterus found to be 14 (2.9%/1000) deliveries. Among these incomplete rupture were 3 (21.4%) and complete rupture were 11 (78.4%). Regarding the common sites of uterine rupture lower uterine segment interior surface = 11 (78.4%). Lower uterine segment posterior surface = 2 (14.2%) and upper uterine segment rupture was = 1 (7.14%). The most common cause of uterine rupture was found to be multiparity and injudicious use of oxytocin by TBA in 5 cases. (35.7%) and previous uterine surgery in 5 cases (35.7%). 2 cases (14.21) were due to cephalopelvic disproportion due to hydrocephalus and 2 (14.2%) cases were of malpresentation (transverse lie) mostly handled at home by TBAs. Hysterectomy, total or sub total was done in 7 cases (50%). Repair of uterus was done in 5 cases (35.7%), in 2-cases (14.2%). Bladder repair alongwith uterine repair was done. In two cases (14.2%) of scar dehiscence, repeat cesarean section was done. The maternal mortality was found to be zero, while intrauterine death were 10(71.4%) and alive babies were 4 (28.5%) high perinatal mortality of 71% were found. Conclusion: Ruptured uterus is avoidable catastrophe by proper education, training of patients and TBA`s and by providing effective family planning services, transportation, diagnostic facilities and by reducing the unnecessary caesarean section.