Rupture of the uterus: a changing picture

Eighty nine cases of rupture of the gravid uterus occurring over a period of 15 years with 77,133 deliveries, were analysed. The overall incidence of ruptured uteri was 1 per 866 deliveries. The patients were divided into two groups, those with a scarred uterus (47) and those with an unscarred uterus (42). Distinct differences in terms of parity, age, aetiology and pathogenesis, the clinical picture, pathology, type of surgery and outcome were seen between the two groups. Most pronounced was the difference in symptoms and signs. Lower abdominal tenderness (38.2%), and vaginal exploration after delivery (44.6%) were the clinical hallmarks in the scarred uterus group, compared to shock (33.3%), uterine bleeding (30.9%) and severe abdominal pain (23.8%) in the unscarred group. Moreover, conservative surgery was possible in 72.3% of the scarred group against 14.3% in the other group. A maternal mortality of 5.6% and fetal mortality of 52.8% was seen. All maternal deaths and 71.4% of fetal losses occurred in the unscarred group. Fortunately, the number of ruptures clearly decreased over the study period, and furthermore the ratio between spontaneous and traumatic ruptures of an unscarred uterus and ruptures of a scarred uterus increased.