Risk Factors and Outcome Analysis in Rupture of Gravid Uterus: Lessons for Obstetricians

Abstract

Objective This study was conducted to determine the risk factors and feto-maternal outcomes in uterine rupture at a tertiary care centre, with the goal to assess the delays or gaps in management, in order to avert associated morbidity and mortality. Material and methods This study was conducted from June 2018 to May 2020 in Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, wherein all women diagnosed with uterine rupture, either at the time of admission or during the course of hospital stay, were included after taking written informed consent. The primary outcome measured was the incidence of uterine rupture, whereas the secondary outcomes assessed were clinical features, risk factors, per-operative findings, management, and feto-maternal outcomes. Results The total number of deliveries during the study period was 67005. Out of these, 12985 women underwent LSCS, whereas others delivered vaginally. A total of 61 cases of uterine rupture occurred among them. The majority of these women were unbooked (62.29%), having a gestation age >37 weeks (65.57%). The most common risk factor identified was a history of previous LSCS (91.80%). Around 80.33% of women had rupture of the lower segment of the uterus. Maximum cases were managed by repair with ligation (63.93%), while 26.22% underwent hysterectomies. Bladder injury occurred in 11.48% of women. While most of the women required blood transfusion (93.44%), only three maternal deaths occurred. Conclusion Rupture of a gravid uterus can be a lethal surgical catastrophe with potentially grave feto-maternal consequences. Alacrity in diagnosis and referral to a tertiary centre, along with facility-level preparedness to respond to this emergency, apart from optimal care around birth, are critical determinants for feto-maternal survival.