A Clinical Study of Uterine Rupture

Park, So Jeong; Ki, Da Rin; Park, Ji No; Cho, Moon Kyoung; Kim, Ki Min; Kim, Cheol Hong; Kim, Yoon Ha; Song, Tae Bok

Abstract

Uterine rupture is one of the most feared obstetric complications, carrying a great risk of maternal and perinatal morbidity and mortality. The aim of this study is to review associated factors with uterine rupture, to find out predicting factors and to help deciding the delivery method best suited for mother and baby. This report reviewed 36 cases of uterine rupture diagnosed among 22,657 obstetric deliveries at Chonnam National University Hospital from January 1983 through December 2004. There were total 36 cases of uterine rupture. Among them 34 women had a history of previous cesarean delivery. 16 cases suffered complete uterine rupture, and 20 cases incomplete uterine rupture (dehiscences). 36 cases of uterine rupture were composed of 1 traumatic rupture, 34 cesarean section scar ruptures, and 1 spontaneous rupture Traumatic rupture resulted from oxytocin and misoprostol induction. Symptoms and signs such as abdominal pain and tenderness, fetal heart rate change were significantly related with uterine rupture; however 11 cases of 20 dehiscences were asymptomatic. Maternal mortality was 2.8% (1 case) which resulted from spontaneuos uterine rupture and perinatal mortality was 28% (10 cases). Nine out of the ten neonatal deaths resulted from uterine rupture had a history of maternal previous cesarean section. To reduce the risk of maternal and perinatal morbidity and mortality from uterine rupture, appropriate delivery plan according to a patient's underlying status is most important. It should include assessment of the type and site of previous cesarean section, in addition to judicious use of oxytocin, and intrapartum monitoring for nonreassuring status.