Rupture of the pregnant uterus - a 20-year review.

OBJECTIVES To examine the incidence, causative factors, maternal and foetal outcomes and subsequent fertility in cases of uterine rupture in scarred and unscarred uteri. METHODS A 20 years' retrospective review was carried out where relevant data were collected from the medical records. Outcome measures included labour characteristics, operative procedures, maternal and perinatal outcome in addition to subsequent fertility. RESULTS Forty-nine cases of complete uterine rupture were identified. Women in the unscarred group were older, had higher parity and heavier babies (p values < 0.05). Alternatively, the scarred group cases were associated with more silent rupture discovered at time of surgery, recession of the presenting part and more visceral involvement in particularly the urinary bladder. Admission to NICU and birth asphyxia were more frequent in the scarred group while stillbirth and early neonatal death were more common in the unscarred one. Twenty-four out of 49 cases had repair with no bilateral tubal ligation and out of these, 13 patients subsequently conceived and had 22 babies. CONCLUSION Physicians should be vigilant to the risk factors and clinical presentations of uterine rupture during pregnancy. Cautious attempts to repair the ruptured uterus should be tried for patients' wellbeing and to help maintain fertility.