Frequency of uterine rupture at delivery and accompanying risks for the mother and the newborn

Abstract

Background/Aim. Uterine rupture at delivery is a severe life threatening complication for both matter and the newborn. The aim of the study was to determine the frequency of total number uterine rupture within the deliveries, to perceive circumstances and causes that lead to rupture, to establish perinatal and maternal mortality and to present our therapeutic procedure. Methods. In the group of 37 ruptures at 59 660 deliveries from the period 1991-2000 included in this retrospective study we analyzed age, level of education, gestational age, parity, previous caesarian section and other operations on uterus, time of diagnosing rupture, grade and place of rupture, use of Syntocinon and Prostaglandin at delivery, perinatal and maternal mortality, as well as therapeutic procedures at rupture that occurred. Results. The highest influence on uterine rupture in our group had been exerted by previous caesarian section and myomectomy in relation 33 : 4. Incomplete uterine ruptures were more frequent, 26 (70.27%), in relation to complete ones, 11 (29.75%). The most frequent place of uterine rupture was the front wall, 34 (91.89%), two ruptures occurred on the fundus and one on the back wall. The most frequently applied therapeutic procedures were rupture suture in 31 (83.78%) cases, and in six (l6.22%) cases hysterectomy. Perinatal mortality was three times higher than average (17.78?) in that period and was 51.28?. Conclusion. We emphasize that rupture frequency in the total number of deliveries was one rupture at 1 612 deliveries, whereas rupture frequency on the intact uterus was 1 : 17 269, and frequency of uterine rupture after caesarian section was one rupture at 245 deliveries. Our research as well as researches of other authors, showed that a previous caesarian section is the most frequent cause for the occurrence of uterine rupture. Therefore, caesarian section should be avoided whenever possible, not just because of a potential rupture, but also because of more frequent hysterectomy that interrupts woman's reproductive ability.Uvod/Cilj. Ruptura mterice je veoma teska komplikacija u porodjaju i predstavlja veliki rizik za zivot majke i novorodjenceta. Cilj rada bio je da se utvrdi ucestalost rupture materice na ukupan broj porodjaja, sagledaju okolnosti i uzroci koji dovode do rupture, utvrdi perinatalni i maternalni mortalitet i prikazu nasi terapijski postupci. Metode. U grupi od 37 ruptura koje su nastale u periodu 1991-2000. godine na 59 660 porodjaja analizirali smo godine starosti porodilja, stepen obrazovanja, gestacionu starost, paritet, prethodni carski rez i druge opercije na uterusu, vreme postavljanja dijagnoze rupture, stepen i mesto rupture, upotrebu sintocinona (Sy) i prostaglandina (Pg) u porodjaju, perinatalni i maternalni mortalitet, kao i terapijski postupak kod nastale rupture. Rezultat. Analizom dobijenih rezultata utvrdjeno je da godine starosti, obrazovanje, paritet, gestaciona starost i stimulacija u porodjaju nisu imali bitnog uticaja na nastanak rupture materice u porodjaju. Najveci uticaj na rupturu uterusa u nasoj grupi imali su prethodni carski rez i miomektomija u odnosu 33 : 4. Inkompletne rupture uterusa bile su cesce i zabelezene su kod 26 (70,27%) bolesnica, dok su kompletne bile prisutne kod 11 (29,75%) bolesnica. Najcesce mesto rupture uterusa bio je prednji zid kod 34 (91,89%) bolesnice, dve rupture bile su na fundusu i jedna na zadnjem zidu. Najcesce primenjen terapijski postupak bio je sutura rupture kod 31 (83,78%) bolesnice, a kod sest (16,22%) uradjena je histerektomija. Perinatalni mortalitet bio je tri puta veci od prosecnog (17,78?) u tom periodu i iznosio je 51,28?. Zakljucak. Ucestalost ruptura na ukupan broj porodjaja je jedna ruptura na 1 612 porodjaja, dok je ucestalost ruptura na intaktnom uterusu 1 : 17 269, a ucestalost ruptura na uterusu posle carskog reza je jedna ruptura na 245 porodjaja. Prethodni carski rez najcesci je razlog za nastajanje rupture uterusa, te stoga, carski rez treba izbegavati kad god je to moguce ne samo zbog potencijalne rupture, nego i zbog ucestalije histerektomije koja prekida reproduktivnu sposobnost zene.