Rupture uterus in primigravida: morbidity and mortality.

OBJECTIVE This paper is aimed to present "Rupture of the uterus (RU) in primigravida "- unscarred cases which are supposed to be extremely rare. MATERIAL AND METHOD The charts of patients labelled as "Rupture Uterus" for the period 1985 - 2005 AD (2042 - 2061 BS), 20 years were taken out and analysed. RESULT There were 251 cases of rupture uterus during the study period giving the incidence of 0.09% i.e. 1:1100 among live births in a very busy tertiary maternity hospital of capital, Kathmandu of Nepal. There were 60% spontaneous, 29% scar dehiscence and 11% Iatrogenic/traumatic rupture and death due to RU was 7.9%(n=20). Fifteen cases (6%) were primigravid patients -- six were young primi (age 19 and below) and 9 primigravid patients. Five cases were referred from the district hospitals. Ten cases were brought from very far off i.e. more than 50 KM from the city. One case presented at 34, one at 41 and all the others presented between 38 to 40 weeks of gestational age. Only three cases had attended ante-natal clinics. All were having labour pain for more than 48 hours at home. Findings of laparotomy: The lesions found were: ruptured bladder and complete lower segment (CLS) up to the cervix - 1, CLS & cervix -2, complete lower segment (CLS) 1, Complete upper segment (CUS) - 2, Complete upper & lower segment (CULS) - 6, (one had tear at posterior wall of the uterus and the other had tear up to posterior vaginal wall) and Incomplete lower segment (LS) 2. Blood grouping & Rh: six cases had O+, four had A+, four had AB+ and one had B positive. The blood transfusion given was 1 - 4 units. The treatment given was laparotomy and repair in 10; one had LUSCS, repair of bladder and cervical injury. One had repair and bilateral tubal-ligation, one had subtotal hysterectomy and another had hysterectomy & repair of posterior wall of vagina. Four cases were admitted in the state of shock among which 1 had irreversible shock and died before surgical intervention. Another died on the 3rd post-operative day due to convulsions and shock. Maternal mortality (MM) was 13% (2/15) in primips. All cases presented with intrauterine fetal death (IUFD) and had still births (one baby was hydrocephalic). The hospital stay varied from 3 - 170 days. Four cases had vesico-vaginal fistula (VVF) CONCLUSION: Rupture of uterus in primigravida though rare, has been common in developing countries with low socio-economic status.