Clinical Study of Cases of Ruptured Uterus in Pregnancy

INTRODUCTION

One significant obstetric risk is uterine rupture. Even with advancements in contemporary obstetrics, rupture of the gravid uterus continues to be a possibly deadly condition for the baby and mother, particularly in underdeveloped nations (Table 1 and Fig. 1).¹ The incidence is high, because there are a lot of obstetric emergencies, which frequently come from rural areas with inadequate prenatal care.¹

In advanced nations, the occurrence of uterine rupture is about 1% for “women who have had a earlier caesarean section, while it” is highly uncommon (<1 per 10,000) for those who have not.² Uterine rupture is a more common and significant issue in less developed and less advanced countries (Table 2 and Fig. 2). Total range of 0.1–1%.²

Perinatal death varied from 74 to 92%, while maternal mortality was between 1 and 13% (Table 3 and Fig. 3).²

The most crucial elements in enhancing maternal and perinatal outcomes are an early diagnosis, fast treatment of the disease, and timely referral from the level of the gross root.³ The purpose of this retrospective investigation was to assess and examine numerous elements of a uterine rupture (Fig. 4 and Table 4).

MATERIALS AND METHODS

Study design: This is a retrospective analysis conducted at a hospital.

Study place: Katihar Medical College, Katihar, Obstetrics and Gynaecology Department.Study period: June 2021–May 2023.

Study population: A total of 18,521 antenatal admissions, of which 57 were admitted with a ruptured uterus.

• We examined the case sheets of the 57 cases of ruptured uterus that were treated at KMCH, Katihar between June 2021 and May 2023 (Table 5). A number of characteristics were recorded, including parity, clinical presentation, blood transfusion requirement, gestational age, age, surgical finding, type of surgical care, risk factors, and morbidity and mortality in the maternal and perinatal (Table 6).

RESULTS

Incidence Of the total 18,521 antenatal admissions during this period, 57 had ruptured the uterus giving an occurrence of 3.07/1000 deliveries (0.3%).

It is higher, at 1.69%, in developing nations like Nigeria, per a study by Ibrahim SM, Umar NI, et al. In wealthy nations, the occurrence is roughly 10 times lower. In Australia, it is 0.086%, according to research by Lynch JC, Pardy JP, et al.

MORTALITY

Two (3.5%) cases of maternal death and 51 (89.5%) cases of perinatal mortality were documented.

DISCUSSION

A ruptured uterus is a treatable but possibly fatal illness that needs to be diagnosed and treated very soon. The occurrence of a ruptured uterus in the current investigation was 0.3%. Mahbuba and Alam (0.83%) and Alam et al. (1.14%) studies found a higher incidence.^4,5 As a tertiary referral center, the majority of cases that come to our hospital are already in a moribund state. Research carried out in developing countries also revealed that the occurrence of ruptured uterus was primarily determined by the low socioeconomic status of the population and inadequate health facilities in rural areas.

About 59.7% of the cases in this study with previously scarred uterus had ruptured uteruses. 40.3% of uterus that are not scarred. The same significant frequency of uterine rupture in the unscarred uterus was additionally observed in Saini VK et al. study. Most cases of untreated obstructed labor, which are common in rural areas, lead to uterine rupture in an unscarred uterus.⁶ In 54.4% of the instances in the current study, multiparous women had a ruptured uterus. It was greater than the Malik HS research (42.7%).⁷ The primary treatment methods included laparotomy and rapid resuscitation. Only 29.8% of the cases could be repaired, which is lesser than the 39.2% of cases in the investigation by Rathod S et al.⁸ Perinatal mortality was recorded at 89.5%. Research by Rathod et al. found a similar outcome (90.5%). The current study’s maternal death rate of 3.5% was comparable to Sahu L result of 2.76%.^8,9

CONCLUSION

A major and possibly deadly consequence for both the mother and the unborn baby is uterine rupture. The occurrence of uterine rupture is extreme in underdeveloped nations, such as India, and it is significantly higher in unscarred uteruses than in developed nations. The occurrence of “rupture uterus” may be decreased with education and appropriate care, particularly for high-risk individuals who have had an earlier caesarean section. Early identification and management of protracted labor can also help to stop additional obstruction and rupture. Early referral and appropriate oxytocic usage are also crucial.¹⁰

REFERENCES

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