Complete Uterine Rupture a Stigma for Modern Obstetrics: An Observational Study

Aims: To know the maternal and perinatal outcome in women with complete uterine rupture. Background: Uterine rupture is a catastrophic obstetric event associated with high maternal, perinatal morbidity, and mortality. Objectives: The present study was conducted to know prevalence, risk factors, presentation, the maternal, perinatal outcome in women with complete uterine rupture. Methods: Present retrospective observational study was conducted on 31 women admitted to the Obstetrics ward of the rural tertiary center of Northern India with complete uterine rupture between January 2016 and December 2018 after Institutional ethical committee approval and informed written consent from participants. Data included socio-demographic parameters, gestation, predisposing factors, clinical features, site of rupture, associated bladder injury, need for hysterectomy, perinatal, and maternal outcome. Statistical analysis was conducted using Statistical Package for the Social Sciences software version 22.0. Results: Of the total of 9,156 deliveries during the study period, 31 women had a uterine rupture, indicating the prevalence of 0.34%. Of all 21(67.7%) women had an unscarred uterine rupture, and 10(32.3%) scarred uterine rupture. The majority cases were un-booked (77.4%), multiparous (90.3%), and term at gestation (66.7%), with an average age of all cases as 26.97±3.73 years. The most common risk factor was injudicious use of oxytocic (29.0%) and previous cesarean section scar (22.6%). The most common site of unscarred uterine rupture was the lower uterine segment (26.7%) and in the scarred uterus, the site of previous cesarean section (26.7%). Eight (25.8%) women had bladder injury. Total 24 (77.4%) fetuses were stillborn. Seventeen (54.8%) women needed hysterectomy as a lifesaving procedure, and three (9.7%) succumbed to death despite all resuscitative measures. Conclusion: Hence, complete uterine rupture is common in rural areas and is a serious obstetric emergency with high perinatal, maternal morbidity, and mortality. As most of the cases of complete uterine rupture occur in unbooked women hence, motivating all antenatal women for regular antenatal visits can prevent the dreadful condition to a large extent, thereby saving many maternal and fetal lives.