Uterine Rupture after Previous Cesarean Section and Feto-Maternal Outcome

Fozia Shaikh, Shazia Shaikh, Tanweer Akhtar, Basma, Shaista Lashari

Abstract

Objective

To determine the frequency of uterine rupture after previous cesarean section and feto-maternal outcome.

Study design

Descriptive case series.

Place & Duration of study

Department of Obstetrics & Gynaecology, Sheikh Zaid Women Hospital Unit 1, SMBBMU Larkana, from February 2018 to August 2018.

Methodology

All women with history of previous caesarean section admitted in the gestational age of 28 weeks and above were the part of this study. All the patients of rupture of uterus were admitted in labour room through emergency or out patients department. They were thoroughly inquired as per the questions of pre-design form. Diagnosis was made accordingly after taking history, physical examination and was confirmed on laparotomy. Upon history taking, previous obstetrical, surgical, medical, maternal and fetal outcomes were inquired. Symptoms which indicated rupture of uterus were; shortness of breath, abdominal distention, loss of uterine contour, palpable fetal parts, absent fetal heart sounds and bleeding per-vagina. Women with history of myomectomy or any uterine surgery and those with parity of more than one were included in this study. Patients with abruptio placentae, placenta previa and congenital uterine anomaly were excluded from study.

Results

Overall 169 women were managed. Mean age of the participants was 29.77±2.38 years and the mean gestational age was of 37.40 ± 0.875 weeks. The mean parity was 2.79±0.892 with minimum and maximum parity of 2 and 6 respectively. The mean number of previous cesarean sections was 1.52 ± 0.627. There were 92 (54.4%) females who had one previous cesarean section, 65 (38.5%) had two and 12 (7.1%) had 3 cesarean sections. According to maternal outcome 14 (8.3%) deaths occurred due to uterine rupture. According to fetal outcome 42 (24.9%) fetuses were alive and with Apgar score >7. Moreover, 9 (5.3%) fetus born with low Apgar score <7 and died within 24 hours of their birth, while 118 (69.8%) were found dead.

Conclusions

The study concluded that neglected and poorly managed cases, along with grand multipara, injudicial use of oxytocin and instrumentation were the main causes of rupture of uterus. A review of already present protocols is needed to minimize the risk of uterine rupture and associated maternal & perinatal morbidity and mortality.

Key words

Cesarean section, Uterine rupture, maternal mortality, fetal outcome, APGAR score.