Rupture uterus: a 10-year retrospective study

Abstract

In modern obstetric practice uterine rupture is a rare complication associated with increased maternal and perinatal morbidity and mortality. The aetiology remains controversial and the incidence varies depending upon institutional practices. In this study we have sought to look into the changing trends of uterine rupture over the last decade at the National Maternity Hospital, Dublin. We reviewed casenotes of women with uterine rupture from 1992 to 2001. This was a retrospective study of 22 casenotes from 1992–2001. This included all patients who had uterine rupture antenatally or intrapartum confirmed by the operation notes. The rupture was classified as complete if the full thickness of the uterine wall was involved and incomplete if the visceral peritoneum remained intact. The incidence of uterine rupture over the decade is 0.028%, the total number of cases being 22. Twenty-one of 22 (95.45%) women had had a previous caesarean section (CS). Of these two had two previous CS (9.52%). Eighteen of 21 (85.71%) had previous sections at term and 18/21 were emergency sections while 3/21 were elective. In the current pregnancy uterine rupture occurred at term in 21/22 (95.45%). Thirteen women (59.0%) had spontaneous labour without oxytocics or were not in labour. Oxytocin was used for augmentation in 7/22 (31.81%) and prostaglandins in 2/22 (9.09%). The clinical presentation for the diagnosis were cardiotocogram abnormalities in 72.72% and maternal symptoms of pain and vaginal bleeding in 45.45%. Eighteen of 22 (82%) women were 1–6 cm dilated at the time of diagnosis. Complete rupture occurred in 8/22 (36.36%) and incomplete rupture in 14/22 (63.63%) women. Fifty-four per cent had extension of the uterine scar observed during surgery. Maternal morbidity included one case each of caesarean hysterectomy and vesico-vaginal fistula, respectively. There was no maternal mortality. There was 18.2% perinatal mortality and 13.6% admissions to the special care baby unit.