Complete Uterine Rupture: A Catastrophic Obstetric Emergency
Amna Shahid , Maryam Zulfiqar
Keywords: Cesarean section, uterine rupture, maternal mortality, fetal morbidity, hysterectomy
ABSTRACT
Introduction: Complete uterine rupture is a critical obstetric emergency involving full-thickness disruption of the uterine wall and visceral peritoneum. It often results in severe maternal and fetal complications, necessitating immediate intervention.
Objective: This study aims to determine the incidence, risk factors, and maternal-fetal outcomes associated with complete uterine rupture in a tertiary care setting.
Methods: A retrospective observational study was conducted in the Obstetrics and Gynecology Department of Lahore General Hospital, Lahore. Records of 64 cases of complete uterine rupture managed between June 2022 and July 2023 were analyzed. Key factors such as previous cesarean scars, cephalopelvic disproportion, antenatal care status, surgical management, and maternal-fetal outcomes were evaluated.
Results: The incidence of uterine rupture was 1 in 90 deliveries (1.1%). The most frequent cause was rupture of a previous cesarean scar (59.61%), followed by grand multiparity (17.18%), cephalopelvic disproportion (21.8%), and neglected malpresentations (12.5%). Nearly half (48.07%) of the cases lacked regular antenatal visits, while 30.76% were unbooked. The lower uterine segment was the most affected (80.76%), with bladder injury reported in 15.4% of cases. Maternal mortality was 15.6%, while perinatal mortality reached 76.6%.
Conclusion: Uterine rupture remains a preventable yet life-threatening obstetric emergency. Proper antenatal counseling, early risk identification, and vigilant intrapartum care can significantly reduce its incidence. Timely surgical intervention and effective management of hemorrhagic shock are crucial for improving maternal and fetal survival.
Keywords: Cesarean section, uterine rupture, maternal mortality, fetal morbidity, hysterectomy