Uterine Rupture: Shifting Paradigm in Etiology

Background Rupture uterus is associated with significant maternal and perinatal mortality and morbidity. Etiologies of uterine rupture are changing with time. There has been shift in etiology from an obstructed labour and multiparity towards rupture of a caesarean section scar. There is paucity of studies regarding this changing paradigm. Objective To study the changing etiological pattern of rupture uterus. Method We retrospectively analysed details of all patients with ruptured gravid uterus from Medical records of Nobel Medical College from 2013 July 1 to 2015 June 30. Sociodemographic predisposing risk factors and feto-maternal outcomes were recorded in a structured proforma. Result Of the 11,571 deliveries, total of 52 (0.45%) had ruptured uterus. Caesarean Section were 3,218 (28%) of total deliveries. Among 52 rupture cases, 41 (78.84%) were because of previous Caesarean scar followed by obstructed labor, prostaglandin and oxytocin. The occurrence of rupture in previously scarred uterus was 1.27%. 82.9% of the uterine rupture occurred in women with one previous LSCS. Most women were primipara of 25-29 years. It was seen more commonly in unbooked cases 49 (~95%). Laparotomy with repairment of rupture and bilateral tubal ligation was the commonest mode of management. Majority were anemic. Perinatal mortality was 41 (79%) with 5 (9.6%) maternal deaths. Conclusion Previously scarred uterus is the commonest cause of uterine rupture. Early diagnosis and management is needed to prevent poor outcomes. Avoidance of injudicious cesarean deliveries reduces number of future scars. Awareness generation regarding antenatal care and timely referral are vital.