scholarly journals Uterine rupture: a preventable obstetric catastrophe

2019 ◽  
Vol 9 (1) ◽  
pp. 151
Author(s):  
Bina M. Raval ◽  
Apoorva G. Patil ◽  
Parav D. Shah
Keyword(s):  
Maternal Mortality ◽  
Uterine Rupture ◽  
Treatment Strategies ◽  
Obstetric Care ◽  
Fetal Outcome ◽  
Morbidity And Mortality ◽  
Focused Antenatal Care ◽  
Intact Uterus ◽  
Study Population ◽  
Scarred Uterus

Background: Maternal health has long been acknowledged to be the cornerstone in public health. The objective of this study was to determine the incidence, etiology, risk factors, complications, treatment strategies, maternal and fetal outcome associated with uterine rupture and to determine how to decrease the maternal morbidity and mortality pertaining to it, as it is indeed a preventable obstetric catastrophe!Methods: This is a retrospective study which was carried out in our institute. Analysis of 45 cases of uterine rupture including scar dehiscence, registered/emergency, rupture occurring in the antepartum or intrapartum period, irrespective of previous vaginal or cesarean delivery was done between July 2017 to June 2019 out of 16,330 deliveries. None of the cases were excluded. Statistical analysis was done comparing the mortality in general population and study population and it was determined that it contributes to the maternal mortality significantly hence making it essential to promptly diagnose and treat the cases.Results: The incidence of rupture of uterus is average 0.27% (1 in 362). Out of 45 cases 9 (20%) were registered, and 36 (80%) were referred patients. The 20-30 years age group is the most vulnerable. Scarred uterus undergoing rupture were 34 (75.55%) as compared to rupture in intact uterus which were 11 (24.44%). The commonest modality of treatment used is suturing of tear which was done in 34 (75.55%) followed by total hysterectomy. There were 2 maternal deaths giving maternal mortality rate of 4.44% and perinatal mortality occurred in 18 (40%) cases.Conclusions: Uterine rupture is a dire emergency with a high incidence of maternal and fetal morbidity and mortality. Skilled attendance with accessible obstetric care, focused antenatal care, strict intrapartum monitoring and good surgical approach are key elements for the prevention and management of uterine rupture.

scholarly journals Pregnancy Outcomes and Associated Factors for Uterine Rupture: An 8 Years Population-based Retrospective Study

2021 ◽  
Author(s):  
Sheng Wan ◽  
Mengnan Yang ◽  
Jindan Pei ◽  
Xiaobo Zhao ◽  
Chenchen Zhou ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Uterine Rupture ◽  
Obstetric Care ◽  
Developed Countries ◽  
Population Based ◽  
Fetal Heart Rate Monitoring ◽  
Fetal Complications ◽  
History Of ◽  
Scarred Uterus ◽  
Obstetrical Emergency

Abstract Background: Uterine rupture is an obstetrical emergency with serious undesired complications for laboring mothers resulting in fatal maternal and neonatal outcomes. The aim of this study was to assess the incidence of uterine rupture, its association with previous uterine surgery and vaginal birth after caesarean section (VBAC), and the maternal and perinatal implications. Methods: This is a population-based retrospective study. All pregnant women treated for ruptured uterus in one center between 2013 and 2020 were included. Their information retrieved from the medical records department were retrospectively reviewed.Results: A total of 209,112 deliveries were included and 41 cases of uterine rupture were identified. The incidence of uterine rupture was 1.96/10 000 births. 16 (39.0%) had maternal and fetal complications. There were no maternal deaths secondary to uterine rupture, while perinatal fatality related to uterine rupture was 7.3%. Among all case, 38 (92.7%) were scarred uterus and 3 (7.3%) were unscarred uterus. The most common cause of uterine rupture was previous cesarean section, while cases with a history of laparoscopic myomectomy were more likely to have serious adverse outcome. 24 (59%) of the ruptures occurred in anterior lower uterine segment. Fetal heart rate monitoring changes were the most reliable signs for rupture.Conclusions: Incidence of uterine rupture in the study area was consistent with developed countries. Further improvement in obstetric care and strong collaboration with referring health facilities was needed to ensure maternal and perinatal safety.

scholarly journals Mid-trimester rupture uterus: case series

2017 ◽  
Vol 7 (1) ◽  
pp. 342
Author(s):  
Aishwarya Kapur ◽  
Sudha Prasad ◽  
Sangeeta Gupta
Keyword(s):  
Uterine Rupture ◽  
Epigastric Pain ◽  
Rare Event ◽  
Case Series ◽  
Morbidity And Mortality ◽  
Second Trimester ◽  
Third Trimester ◽  
First Case ◽  
Obstetric Intervention ◽  
Scarred Uterus

Uterine rupture is an obstetric catastrophe with significant maternal and fetal morbidity and mortality which occurs mainly in the third trimester of pregnancy or during labour, especially in previously scarred uterus. The occurrence of rupture in first and second trimester in women with unscarred uteri is quite rare. We report two cases of rupture uteri managed in our centre at 24 and 26 weeks gestation in women with unscarred uteri. First case was G3P1L1A1, 24 weeks with epigastric pain, stable vitals, epigastric tenderness, USG inconclusive, CT scan showed out pouching of amniotic sac through fundus. Laparotomy done, there was 8-9 cm fundal rupture extending between cornua, uterine repair done. Second case was G3P1L1A1 26 weeks with abdominal pain, stable vitals, corresponding fundal height, head engaged, USG revealed outpouching amniotic sac at the fundus. Laparotomy performed, there was 10 cm rent extending trans-fundal, uterine repair done. Unscarred uterine rupture, especially in early pregnancy is a rare event, posing significant difficulty in diagnosis. Uterine rupture should be first ruled out in all pregnant women presenting with acute abdomen irrespective of gestational age. Search for non-gynaecological causes can delay crucial obstetric intervention that can lead to loss of obstetric function, morbidity and mortality.

scholarly journals Maternal and Fetal Outcome in Eclampsia: A Study From Tertiary Care Hospital

2017 ◽  
Vol 15 (2) ◽  
pp. 6-9
Author(s):  
Husneyara Haque ◽  
Kalpana Kumari Thapa
Keyword(s):  
Early Recognition ◽  
Tertiary Care ◽  
Fetal Outcome ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Medical College ◽  
Life Threatening ◽  
Study Population

Introduction: Eclampsia is an acute and life-threatening complication of pregnancy associated with elevated maternal and fetal morbidity and mortality. This study was done with the aim to evaluate the maternal and fetal outcome in eclampsia patients and to observe various factors affecting its occurrence and outcome. Methods: A retrospective cross-sectional hospital based study carried out in Nepalgunj Medical College, Nepalgunj from January 2015 to December 2016. Details and data obtained from maternity register were analysed. All patients with eclampsia were included and fetomaternal outcomes measured in terms of complications. Simple descriptive statistical method was applied for analysis. Result: Out of 6056 pregnant women, 46 had eclampsia with the incidence of 7.59 per 1000 deliveries. 58.7% of study population belonged to age group of 21-30 years followed by 36.96% from age less than 20 years. 78.26% cases were unbooked. 73.91% eclamptic patients were primi gravida and 60.87% had gestational age less than 37 weeks. Half of pregnancies with eclampsia underwent ceasarian for delivery and 30.44% required ICU care. One third women developed eclampsia related complications and 2(4.35%) died. Common complications were atonic postpartum heamorrhage (15.21%), psychosis (8.71%) acute renal failure (4.35%). 60.86% newborn were preterm and 56.52% were low birth weight. In 50% newborn, Apgar score at 5 minutes was less than 7. Fetal death was 10.85%. Conclusion: Eclampsia continues to be one of the prime etiological factors for maternal and fetal morbidity and mortality. Therefore early recognition and proper management are vital to tackle this challenge.

scholarly journals Successful Pregnancy after Previous Uterine Rupture

2020 ◽  
Vol 2 (1) ◽  
pp. 99-102
Author(s):  
Kenusha Tiwari ◽  
Aruna Karki ◽  
Ganesh Dangal ◽  
Hema Pradhan ◽  
Ranjana Shrestha ◽  
...  
Keyword(s):  
Uterine Rupture ◽  
Mode Of Delivery ◽  
Breech Presentation ◽  
Obstetric Care ◽  
Emergency Laparotomy ◽  
The Past ◽  
Emergency Cesarean ◽  
Scarred Uterus ◽  
Medical Induction ◽  
Live Baby

Uterine rupture is a rare and catastrophic incidence with high maternal and fetal morbidity rates. It is most commonly seen in the scarred uterus. The unscarred uterus is least susceptible to rupture with the incidencebeing 1 in 8000 deliveries. In the past, pregnancy after uterine rupture was not widely advised and patients underwent hysterectomy or tubal ligation but with the evolving practice, women are motivated for pregnancy which can be successful with proper obstetric care and emphasis on time and mode of delivery. Here we present a case of 31 years old female, gravida-2 para-1 living 0 with previous uterine rupture after medical induction of labor with stillbirth 4 years ago. She underwent emergency laparotomy with the repair. The patient spontaneously conceived and had close antenatal care throughout the pregnancy. The patient was admitted at 34 weeks of gestation and kept under close surveillance. Corticosteroid was administered. She underwent spontaneous labor at 37 weeks of gestation and emergency cesarean section was planned, delivered via a breech presentation to a live baby of 2.4 kg, APGAR score of 8/10, 9/10 at 1 and 5 minutes.

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

2009 ◽  
Vol 66 (8) ◽  
pp. 635-638
Author(s):  
Nedjo Cutura ◽  
Vesna Soldo ◽  
Aleksandar Curkovic
Keyword(s):  
Maternal Mortality ◽  
Uterine Rupture ◽  
Caesarian Section ◽  
Front Wall ◽  
Back Wall ◽  
Level Of Education ◽  
Reproductive Ability ◽  
Intact Uterus ◽  
Therapeutic Procedures ◽  
Life Threatening

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.

scholarly journals Study of cases of rupture uterus in a tertiary institute and its maternal and perinatal outcome

2017 ◽  
Vol 6 (9) ◽  
pp. 4023
Author(s):  
Rupali Atmaram Gaikwad ◽  
Niranjan N. Chavan
Keyword(s):  
Mortality Rate ◽  
Uterine Rupture ◽  
Perinatal Outcome ◽  
Abdominal Hysterectomy ◽  
Cross Sectional Study ◽  
Age Group ◽  
Cross Sectional ◽  
Maternal Deaths ◽  
Intact Uterus ◽  
Scarred Uterus

Background: Uterine rupture is undoubtedly one of the most tragic events that can occur in a women’s life and tragedy becomes more grim when she is young. In India, in advanced cities the incidence of rupture preceded by obstructed labour is decreasing, in rural parts where there is inadequate care, lack of communication and transport, home deliveries by untrained dais incidence of rupture uterus is still high. So, the study is to evaluate the etiological factors, incidence, management modalities and maternal and perinatal outcome.Methods: A prospective cross-sectional study of 46 cases of rupture uterus and maternal and Perinatal outcome, in the department of Obstetrics and Gynecology in government tertiary reference center.Results: Overall incidence of uterine rupture is 1 in 924. Out of 46 cases 07 (15.22%) were booked, and 39 (84.78%) were referred patients. The 20-30 years age group is the most vulnerable age group. Out of 44 rupture uterus during labor, 13 (22.72%) were spontaneous of intact uterus and 31(70.45%) were in scarred uterus. Subtotal abdominal hysterectomy was commonest modality of treatment used (28 out of 46 cases), followed by suturing of tear. There were 5 maternal deaths out of 46 patients, giving maternal mortality rate of 13.51%. Perinatal mortality rate still on higher side was 76.08%.Conclusions: Most cases of rupture uterus are preventable with good antenatal and intra-partum care. Our study shows that there has been a decline in the overall morbidity in cases of rupture uterus and so also the mortality rate (decreased from 24.3 to 13.51%).

Complications of Pregnancy

2021 ◽  
pp. 103-137
Keyword(s):  
Maternal Mortality ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Medical Abortion ◽  
Fetal Outcome ◽  
Reproductive Age ◽  
Medical Interventions ◽  
Obstructed Labour ◽  
Primary Means ◽  
Maternal Sepsis

Although the majority of pregnancies are uneventful, sometimes complications do happen. Pregnancy complications are the conditions or pathological processes associated with pregnancy. They can occur during or after pregnancy and range from minor discomforts to serious diseases that require medical interventions. They can involve the mother's health, the baby's health, or both. Complication of pregnancy can cause maternal morbidity and mortality. The most common causes of maternal mortality are maternal bleeding, maternal sepsis, hypertensive disease, obstructed labour, and pregnancy with the consequence of abortion, which includes miscarriage, ectopic pregnancy, and medical abortion. The primary means of preventing maternal deaths is to provide rapid access to emergency obstetric care, including treatment of haemorrhage, infection, hypertension, and obstructed labour. Proper antenatal care can reduce the maternal mortality rate by reducing the number of pregnancies among women of reproductive age. Thus, adequate monitoring and appropriate intervention strategies should be provided for better maternal and fetal outcome.

scholarly journals Observational study of maternal and fetal outcome in obstetric emergencies admitted to tertiary care centre

2021 ◽  
Author(s):  
Neelima Singh ◽  
Sreedevi . ◽  
Sushma .
Keyword(s):  
Maternal Mortality ◽  
Perinatal Mortality ◽  
Tertiary Care ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Fetal Outcome ◽  
Tertiary Care Centre ◽  
Cervical Injury ◽  
Mortality And Morbidity ◽  
Obstetric Emergencies

Background: Objectives of the current study were to evaluate the risks factors, clinical presentations, the management and maternal and fetal outcome of common obstetric emergencies encountered at Government general hospital Nizamabad, Telangana, from April 2019 to November 2019.Methods: It is an Observational, hospital-based study done department of obstetrics and gynaecology in 160 cases of obstetric emergencies managed in 8 months study period were reviewed.Results: Out of 3000 deliveries there were 160 cases of obstetric emergencies giving a percentage of 5.33%. About 84% had antenatal care and 16% had not taken ANC with perinatal mortality of 91.9% in booked cases. Out of 160 cases of obstetric emergencies, obstetric haemorrhage constituted 94 (58.75%) cases and among those cases, 23 cases (24.5%) were PPH including both atonic and traumatic, abruptio placenta constituted 35 cases (37.3%). Out of 160 cases of obstetric emergencies, obstructed labour constituted 29 cases (18.1%) being a frequent indication for emergency caesarean section, 1 case of septic abortion and 30 cases eclampsia. 29 perinatal deaths giving the perinatal mortality rate as 181 per 1000 live births. One maternal mortality due to rupture uterus. Maternal morbidity was in the form of wound infections which was found in 6 cases (3.75%), wound gaping in 2 cases (1.25%) PPH in 19 cases (11.81%), septicaemia in 17 cases (10.6%), puerperal pyrexia 6 cases (3.7%), vaginal or cervical injury 6 cases (3.7%), ICU admissions in 9 cases (5.6%). This morbidity increased the number of days of hospital stay to the patients.Conclusions: In majority of cases, the complications are preventable and treatable with proper antenatal and intranatal care. Identification of high risks cases, education of people about the importance of supervised pregnancy, delivery and emergency obstetric care will reduce the maternal mortality and morbidity and perinatal mortality and morbidity significantly.

scholarly journals Maternal and fetal outcome in oligohydramnios after 34 weeks of gestation

2018 ◽  
Vol 7 (11) ◽  
pp. 4604
Author(s):  
Mahantappa A. Chiniwar ◽  
Joe Kaushik M. ◽  
Sharada B. Menasinkai
Keyword(s):  
Amniotic Fluid ◽  
Fetal Outcome ◽  
Morbidity And Mortality ◽  
Research Centre ◽  
Control Group ◽  
P Value ◽  
Study Group ◽  
Perinatal Morbidity ◽  
Amniotic Fluid Index ◽  
Chi Square

Background: Oligohydramnios is one of the major causes of maternal and perinatal morbidity and mortality. It is a clinical condition characterized by Amniotic Fluid Index (AFI) ≤5 cm by sonographic assessment. The aim of present study is to know the maternal and fetal outcome in oligohydramnios after 34 weeks of gestation compared with women who had normal volume of amniotic fluid.Methods: Study was done for the period of 21 months from November 2014-July 2016 at Adichunchanagiri Institute of Medical Sciences, Hospital and Research Centre Bellur. 50 antenatal cases with > 34 weeks of gestation with AFI ≤5 cm by ultrasonographic estimation were included as study group and 50 women with normal AFI were included as control group. Maternal and fetal outcome of the women with oligohydramnios were analyzed and compared with control group.Results: Results were analyzed statistically using parameters like mean, SD, Chi Sq test, P value. Amniotic fluid was clear in 32% in study and 78% in control group, thin meconium stained in 30% in study group and 14%in control group and was thick meconium stained in 38% in study group and 8% in control group (Chi square =22.31, p<0.0001). Induction of labour was done in 54% in study group and 20% in control group. Cesarean delivery was done in 58% in study group women and 28% in control group women. Regarding the birth weight of babies 62% were < 2.5 kg in study group and 18% in control group with p<0.001. 10% of babies in study group required NICU admission and perinatal mortality was 2%.Conclusions: Due to increased perinatal morbidity and mortality and increased rate of LSCS, timely decision during labour is important to reduce perinatal morbidity and mortality.

scholarly journals Universal Maternal Rights: A Matter of Life and Death

2021 ◽  
Author(s):  
Alicia Ryan
Keyword(s):  
Developing Countries ◽  
Maternal Mortality ◽  
Obstetric Care ◽  
Maternal Deaths ◽  
Scientific Methods ◽  
Life And Death ◽  
The World ◽  
Positive Effect ◽  
Multiple Obstacles ◽  
Maternal Rights

Childbirth has been a part of our lives since the beginning of time. Without the process none of us would be alive today. So why is it that maternal mortality remains one of the greatest inequities in the world? To date, approximately 500, 000 women die annually due to the lack of appropriate prenatal and obstetric care. Difficulties arising with childbirth cannot be predicted. However, the way in which we react to a situation can have a lasting, positive effect on the countries and the women who are at risk. The ways in which to help reduce the large number of maternal deaths in developing countries is not complicated and can be achieved if it is made a priority. In conclusion, there are multiple obstacles in regard to succeeding the highest achievable standard of health globally.  With the education of evolving scientific methods, and the collaboration of humanitarian views, the welfare and health of women and their children, can be internationally restored. With the education of evolving scientific methods, and the collaboration of humanitarian views, the welfare and health of women and their children, can be internationally restored.

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