Uterine Rupture: An Analysis of Risk Factors and Complications

Farah Deeba Nasrullah, Zaira Batool, Farah Shabihul Husnain, Riffat Jalil, Saima Shaikh

Abstract

Objective

To analyze the factors responsible for uterine rupture and associated feto-maternal outcome.

Study design

Cross sectional study.

Place & Duration of study

Department of Obstetrics & Gynecology, Civil Hospital / Dow University of Health Sciences Karachi, from January 2021 to December 2022.

Methods

Women of any age group and parity who were admitted and managed with the diagnosis of uterine rupture after 24-weeks pregnancy were included in the study. Data were collected on a predesigned form and entered into SPSS version 20. Descriptive statistics were used to present the data in frequencies and percentages.

Results

During the study period a total of 6240 deliveries were conducted. A total of 53 (0.84%) patients of uterine rupture were managed in this period. Majority of the patients were un-booked (n= 39 - 73.5%) and multiparous (n=31 - 58.4%). Risk factors for uterine rupture included previous cesarean deliveries (n=38 - 71.6%), prolonged/obstructed labor (n=14 - 26.4%), use of oxytocic agents (n=7 - 13.2%), fetal macrosomia (n=3 - 5.6%) and delivery by traditional birth attendants at home (n=10 - 18.8%). 

Maternal complications associated with uterine rupture included blood loss >2000 ml in  17 (32%), hysterectomy in 13 (24.5%), and ICU admission in 29 (54.7%) patients. Sepsis occurred in 07 (13.2%), and urinary bladder injury in 02 (3.7%) patients. There were  05 (9.4%) maternal deaths. This included three patients with unscarred uterus. The rupture sites involved anterior lower uterine segment in 36 (67.9%), the lateral segment in 11 (20.7%), posterior wall in 3 (5.6%), fundus in 2 (3.7%) and more than one sites in one (1.8%) patient. Fetal complications included fresh stillbirth (FSB) in 39 (74.0 %), APGAR <7, in 09 (17.0%) and NICU admission needed in 13 (24.5%) babies.

Conclusion

Uterine rupture was associated with maternal and perinatal morbidity and mortality. Patients with previous cesarean delivery, multiparity, overuse of uterotonic drugs with prolonged and difficult labor were important factors noted in this study.

Key words

Uterine rupture, Maternal morbidity, Obstetric hysterectomy, Fetal demise.