Safia Bibi, Khanda Gul, Zeenat Gul, Palwasha Gul.
Management of Patients with Uterine Rupture.
J Surg Pak Jan ;19(3):117-20.

Objective: To find out the frequency, predisposing factors, maternal and fetal outcomes and mode of management of uterine rupture at a tertiary care hospital. Study design: Descriptive case series. Place & Duration of study: Department of Obstetrics and Gynaecology Unit-4, Bolan Medical Complex Hospital Quetta, from January 2001 to December 2012. Methodology: All patients who presented with ruptured uterus during labor were included in the study. Data on various variables were recorded. This included patient related demography, obstetrical history of previous and present pregnancy and care during labor, hospital course, surgical procedure performed and maternal and fetal outcome. Results: Out of 38,747 deliveries, 201 cases of ruptured uterus were dealt with. This constitutes a frequency of ruptured uterus as 1 in 193 deliveries. Predisposing factors noted were lack of antenatal care (n=180, 90%), grand multiparity (n=100, 49.7%), injudicious use of oxytocin or misoprostol (62.7%), uterine scar (n=74, 36.8%) and residing more than 100 km from tertiary care hospital (n=69, 34.3%). Of the total 41 (20.4%) patients had subtotal abdominal hysterectomy, 60 (29.8%) had repair of ruptured uterus with bilateral tubal ligation and 93 (46.3%) had repair of uterus only. Bladder repair was done in 7 (3.5%) patients. Eighteen maternal deaths occurred in this series. Perinatal mortality was 86.7% (n=185). Conclusions: Uterine rupture remained one of the major causes of maternal and newborn morbidity and mortality. Use of oxytocin, misoprostol and herbs during labor and lack of monitoring were important observations.

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