Uterine rupture incidence, risk factors, and outcome

OBJECTIVE: To determine the incidence of uterine rupture and to analyze risk factors and outcome in a local hospital in Makkah, Kingdom of Saudi Arabia, (KSA).

METHODS: The hospital records of the Maternity and Children's Hospital (MCH), in Makkah, KSA from April 1999 to December 2000 were retrospectively reviewed to identify women with ruptured uterus. The relevant data relating to the clinical features, risk factors, operative procedures, and maternal and fetal outcomes were assessed.

RESULTS: During the study period, there were 23245 deliveries and 23 women were diagnosed to have uterine rupture giving an incidence of one in 1011 deliveries. Fifteen (65.2%) occurred in women with previous cesarean scar and 8 (34.8%) women had no previous uterine surgery. In the 15 women with uterine rupture and previous cesarean section there was no maternal death. They were treated by repair of the uterus. Two women sustained bladder injury, and one subsequently developed vesico-vaginal fistula. In contrast, in the 8 women with no previous uterine surgery, one woman died, one woman developed renal failure, and there were 3 fetal losses. Four women needed total abdominal hysterectomy, and 4 women needed repair. Two women needed internal iliac ligation in addition to the hysterectomy.

CONCLUSION: In our circumstances, uterine rupture is not rare and consequences can be life threatening. The outcome is worse in women with unscarred uterus.