Outcomes and Risk Factors Analysis of Rupture of the Scarred and Unscarred Gravid Uterus: A 30 Years Review in a Single Saudi Center

Background: Uterine rupture (UR) in pregnancy is a rare devastating obstetrical complication that can have catastrophic consequences. Perinatal morbidity and mortality is significant and maternal mortality due to extensive damage to the uterus and blood loss has been documented.

Objective: To review the incidence and maternal and perinatal outcome of uterine rupture in pregnancy, to compare risk factors, site of rupture, and outcome of uterine rupture among patients with a scarred versus an unscarred uterus, and Highlights the management approach taken to preserve the women’s fertility potential with follow-up of subsequent pregnancies in these patients.

Results: Hospital records indicated that between January 1987 and December 2017, there were 91 documented cases of complete uterine rupture. Over the study period, 91 pregnancies out of 178,453 deliveries were complicated by complete uterine rupture. The overall incidence was calculated to be 0.05% (1 per 1961 deliveries). Out of the 91 patients, 70 had prior history of a scarred uterus and 21 had no scarred uterus. The average age of patients with an unscarred uterus was significantly older (34.0 ± 1.6 years) than that of patients with a scarred uterus (27.2 ± 0.8 years). In terms of parity, almost a third of the overall study population (30.7% n=28) was defined as grand multipara (≥ 5 previous deliveries) with a higher proportion amongst the unscarred uterus group (71.4%, n=15) compared to patients with a scarred uterus (25.7%, n=18). The gestational age at which the rupture occurred was significantly more advanced for the patients with an unscarred uterus (39+6 weeks ± 3 days) in comparison to patients with a scarred uterus (37+6 weeks ± 6 days).

Conclusion: Antenatal care is vital, not to prevent or predict uterine rupture but to highlight the high-risk cases that need more care. For all patients in labor there should be a low threshold of suspicious for ruptured uterus, in particularly high risk patients that develop abnormality in fetal heart pattern or any abnormal per vaginal bleeding. The most senior expert obstetrician should deal with the surgical management. Reservation of fertility should be a target especially in conservative communities without compromising maternal health.

Author(s): Al-Wadi K, Chamsi AT, Farid G

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