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Original Article

Uterine rupture: A catastrophic obstetric emergency

B. Kavitha, G. C. Prabhakar, K. Shaivalini
Department of Gynecology and Obstetrics, Mamata Medical College and General Hospital, Khammam,
Andhra Pradesh, India

ABSTRACT
Background: Uterine rupture can be a catastrophic obstetrical emergency with high incidence of fetal and maternal morbidity and
mortality, varying from 1 in 2000 to1 in 200 deliveries.
Aims and objective: To investigate the incidence, etiology, diagnosis, treatment and outcome of uterine rupture.
Material and Methods: Thirteen cases of major rupture of the pregnant uterus in which life of the mother and fetus were endangered
are presented. This study examined all cases of ruptured uterus managed in the Department of Obstetrics and Gynaecology at Mamata
General Hospital, Khammam over a 3 year period. Details were obtained from medical records retrospectively and analyzed manually.
Results: All 13 cases had varied etiologies and presentations such as poor antenatal care, previous cesarean section scar was
present in 8, uterine anomalies were noted in 3, history of trauma was present in 1 case, and 1 case was grand multipara who set
into spontaneous labour. Sonography findings in all cases showed an empty uterus surrounded by echogenic intra-abdominal fluid
(haemoperitoneum) with dead fetus and placenta in maternal abdomen. Most patients were in shock and required basic life support,
IV fluids, blood transfusion and emergency laparotomy. Few required intensive care and ventilator support. There were no maternal
deaths and 100% perinatal deaths were seen.
Conclusion: This study confirms previous cesarean section scar as the predominant cause of uterine rupture which can be prevented
by regular antenatal care and mandatory institutional delivery.

Key words: Cesarean section, laparotomy, rudimentary horn, rupture uterus

INTRODUCTION A uterine rupture is a life-threatening event for

Uterine rupture can be a catastrophic obstetrical
emergency with high incidence of fetal and maternal
morbidity and mortality, varying from 1 in 2000 to1
in 200 deliveries.
Most reported cases occur in patients with risk factors
for uterine rupture, most notably labor after previous
uterine surgery and grand multiparity.[1]
Address for correspondence:
Dr. K. Shaivalini, Department of Gynecology and Obstetrics,
Mamata Medical College and General Hospital,
Khammam ‑ 507 002, Andhra Pradesh, India.
E‑mail: shyvalinik@gmail.com
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the mother and the baby. A uterine scar from a
previous cesarean section is the most common risk
factor, Other risk factors are full-thickness incisions,
dysfunctional labor, labor augmentation by oxytocin
or prostaglandins, and high parity and trauma. In
this socioeconomic environment, the management of
all obstetric emergencies is likely to be extremely
difficult.
MATERIALS AND METHODS
This study examined all cases of ruptured uterus
managed in the Department of Obstetrics and
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DOI: How to cite this article: Kavitha B, Prabhakar GC, Shaivalini K. Uterine
rupture: A catastrophic obstetric emergency. J NTR Univ Health Sci
10.4103/JDRNTRUHS.JDRNTRUHS_16_14
2017;6:251-4.

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Kavitha, et al.: Uterine rupture

Gynaecology at Mamata General hospital, Khammam

over a 3 year period.

Details were obtained from medical records

retrospectively and analyzed manually.

RESULTS

Complete uterine rupture occurred in 13 cases, with

an incidence of 1:248. The ages of the women
ranged from 18 to 32  years. All were multigravida.
Seven were term, 3 preterm, and 3 were second
trimester ruptures in uteri with congenital anomalies.
All 13 cases had varied etiologies and presentations
Figure 1: G2P1L1 with term gestation with lower uterine segment
such as poor antenatal care, previous cesarean section rupture
scar was present in 8, uterine anomalies were noted
in 3, history of trauma was present in 1 case, and
1 case was grand multipara who set into spontaneous
labour. Sonography findings in all cases showed an
empty uterus surrounded by echogenic intraabdominal
fluid  (hemoperitoneum) with dead fetus and placenta
in maternal abdomen. Most patients were in shock
and required basic life support, intravenous fluids,
blood transfusion, and emergency laparotomy.
Few required intensive care and ventilator support.
Operative management included uterine rent repair
with bilateral tubal ligation in 8  cases [Figures 1-3],
excision of ruptured uterine horn with unilateral tubal
ligation in 3  cases [Figures 4 and 5], and subtotal
hysterectomy in 2  cases [Figures 6 and 7]. There were
no maternal deaths and 100% perinatal deaths were Figure 2: G2P1L1 with term gestation with lower segment scar
rupture
seen [Tables 1, 2].

DISCUSSION

Among the women in this series, the lack of any

antenatal care is strikingly frequent  –  100%. However,
this lack of antenatal care probably reflects the lack
of access to obstetric care in general. It is the lack
of access to emergency obstetric care, in particular

TABLE 1: RISK FACTORS

Previous cesarean 8
Uterine anomalies 3
Multiparity 1
Trauma in a RTA 1

TABLE 2: OPERATIVE MANAGEMENT Figure 3: Fetus and placenta found on opening the abdomen.
Uterine rent repair with bilateral tubal ligation 8 G3P1D1A1 19wks GA with bicornuate uterus
Excision of ruptured uterine horn with 3
unilateral tubal ligation emergency cesarean section and blood transfusion,
Subtotal hysterectomy 2 that is the problem in many developing countries.[2,3]
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Kavitha, et al.: Uterine rupture

Figure 4: G2P1L1 with 20 weeks GA with ruptured rudimentary

horn Figure 5: G2P1L1 with 18wks gestational age with rupture of right
horn of uterus

Figure 6: G2P1L1 with term gestation with fundal rupture (road

traffic accident) Figure 7: G5P4L4 with 36 weeks GA with fundal rupture in
spontaneous labour

In this study, the most common etiology was

previous cesarean section. One had road traffic
accident who has underwent complete uterine rupture.
Emergency laparotomy was done for a rent of 8cm
on anterior surface of uterus which was extending till
fundus. Rent repair was done. Three had bicornuate
uterus with pregnancy in one horn who had a vaginal
delivery during her first pregnancy. [4] The other
underwent a prolonged second stage at home before
seeking help at a local health post. Eventually she
was referred to our hospital where she was promptly
taken to the operating theatre for cesarean section.
The uterus was found to be completely ruptured with
the baby dead.
Most cases were diagnosed clinically and ultrasound
aided to clinical diagnosis. Most were in shock
and required 2–3 blood transfusions. Few required
intensive care and ventilator support. Operative
management included uterine rent repair with
bilateral tubal ligation in 8  cases, excision of
ruptured uterine horn with unilateral tubal ligation in
3 cases, and subtotal hysterectomy in 2 cases. There
were no maternal deaths, and 100% perinatal deaths
were seen.
However, with an increasing cesarean section rate,
a further increase in the number of ruptured in
uteri might be expected in the future. This leads to
either injudicious intervention and/or further delay in
transferring to a hospital. Most women in our series
were illiterate and tribal people where transport and
medical facilities are unsatisfactory.
The location of the uterine rupture was extremely
varied. The majority, even those with no history of
previous lower segment sections, involved the lower

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Kavitha, et al.: Uterine rupture

segment, often transversely across the anterior surface.
It was frequently associated with extension to adjacent
structures, causing difficulty in repairing the rupture,
often necessitating hysterectomy. Hence, with regular
antenatal care and mandatory institutional delivery we
can avoid this obstetric tragedy.
CONCLUSION
This study confirms previous cesarean section scar as
the predominant cause of uterine rupture which can
be prevented by regular antenatal care and mandatory
institutional delivery.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Rashmi, Radhakrisknan G, Vaid NB, Agarwal N. Rupture Uterus:
Changing Indian Scenario. J Indian Med Assoc 2001;99:634-7.
2. Gardeil F, Daly S, Turner MJ. Uterine rupture in pregnancy reviewed.
Eur J Obstet Gynecol Reprod Biol. 1994;56:107-10.
3. Ofir K, Sheiner E, Levy A, Katz M, Mazor M. Uterine rupture: Risk
factors and pregnancy outcome. Am J Obstet Gynaecol 2003;189:1042-6.
4. Nahum GG. Uterine anomalies, induction of labor, and uterine
rupture. Obstet Gynecol 2005;106:1150-2.

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