Rupture of the pregnant uterus

Ninety-three incidents of uterine rupture are reviewed. There is a distinct difference in both the fetal and maternal outcome between the group with a previously scarred uterus and the group with no previous scarring. Rupture of the unscarred uterus is a more dramatic event. The most common etiologic factors appear to be oxytocin, cephalopelvic disproportion, grand multiparity, and abruptio placentae. Abruptio placentae was diagnosed in almost half the maternal deaths. When the uterine tear is longitudinal, the maternal and fetal prognosis is relatively poor. Fetal mortality is much higher in patients with an unscarred uterus. Hysterectomy was more commonly performed in this group. Rupture of a previously scarred uterus is usually incomplete and the tear is transverse. Maternal and fetal prognosis is much better and repair of the uterus with sterilization is more often feasible in this situation.