Changing Trends of Uterine Rupture Cases Over Three Decades

Abstract

Background: Uterine rupture is associated with significant maternal and neonatal morbidity and mortality.

Objective: The study described the causes of uterine ruptures concerning maternal morbidity and fetal outcomes. Causes of ruptured cases from the same setting were compared between the years 2001, 2011, and 2021.

Materials and Methods: A cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Lady Reading Hospital (LRH), Peshawar. Forty-three women who had been diagnosed with uterine rupture were included in the study. Information on age, parity, causes of rupture, surgical management, maternal morbidity, and outcome of the fetus, was recorded on a predesigned proforma. Repair procedures, STAH (subtotal abdominal hysterectomy), and internal iliac artery ligation were performed as per requirements.

Results: Sixty two 62.8% of women fell in the 35 years and above age group. Mostly (62.8%) were grand multigravida. The commonest cause of uterine rupture was mishandled labor by traditional birth attendants (44.2%) and followed closely by scar dehiscence (37.2%). The commonest procedure (58%) was STAH. Eighty one percent81.4% of women had no complications. Sixty seven percent (67.4%) of fetuses died due to complications and 32.6% survived. Causes ‘mishandled by untrained attendants' (44.2%) and ‘previous C-section scar’ (37.2%) were recorded with increased percentages in 2021. More cases of direct trauma (8%) and obstructed labor (32%) were reported in the year 2001, as compared to other years.

Conclusion: The percentage of rupture of the uterus was lower (0.56%) in 2021, as compared to 2001 and 2011. The negligence of traditional delivery attendants contributed significantly to the mismanagement, resulting in morbidity and mortality in women and their fetuses. Complications should be checked if healthcare professionals scrupulously follow established standards and surgical procedures are conducted by a competent physician