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Indian Journal of Obstetrics and Gynecology Research


Rupture of Unscarred Pregnant Uterus: A Catastrophic Event: Case series and Review of Literature


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Author Details: Naina Kumar, Shaveta Garg

Volume : 4

Issue : 3

Online ISSN : 2394-2754

Print ISSN : 2394-2746

Article First Page : 319

Article End Page : 326


Abstract

Aim: To discuss risk factors associated with rupture of pregnant uterus, its diagnostic dilemmas and associated maternal and fetal complications. Background: Unscarred uterine rupture is rare and associated with high risk of maternal and fetal morbidity and mortality, especially in developing countries.
Case Description: Present case series discusses six cases of unscarred uterine rupture in pregnant women over a period of seven months in rural tertiary care centre of Northern India. All cases were un-booked and were referred for poor maternal condition. There were no maternal mortalities, but uterine rupture in all cases resulted in significant blood loss leading to features of shock, severe fetal distress and fetal deaths (five out of six cases), expulsion of fetus, placenta or both into abdominal cavity, injury to bladder and need for urgent exploratory laparotomy and uterine repair or hysterectomy. All these cases occurred in unscarred uterus and major risk factors were: grand multiparity, injudicious use of oxytocics and or prostaglandins for induction and augmentation of labor, malformed uterus.
Conclusion: Unscarred uterine rupture is increasing in developing countries due to poor health care facilities and lack of awareness amongst pregnant women. There are usually no specific signs for uterine rupture resulting in delay in diagnosis and loss of golden hour period when life of both mother and fetus can be saved. This can be prevented by creating awareness amongst pregnant women about regular antenatal check-ups, hospital deliveries, family planning and training medical and paramedical staffs at periphery for conducting deliveries.
Clinical Significance: Uterine rupture is a preventable catastrophic event with high maternal morbidity and fetal morbidity and mortality.

Keywords:
Fetus; Bladder; Hysterectomy; Placenta; Uterine rupture; Shock

Doi No:-10.18231