12, no. After this procedure, a woman can no. PubMed Interdelivery interval and uterine rupture. Ultrasound diagnosis of a uterine rupture postdelivery is rarely described in the literature. Careers. Among cases, it was found that 15 (11.1%) of prehemoglobin maternal case group levels were below 7g per dl while 19 (7%) in the control group were anemic (Table 2). Emergency exploratory laparotomy with cesarean delivery accompanied by fluid and blood transfusion are indicated for the management of uterine rupture. In the long term, promoting adequate dietary diversity and improving nutritional status at household level, empowering and educating women to access a good health care, avoiding harmful traditional practices, access to skilled care during pregnancy and childbirth, i.e., risk assessment during antenatal care, and close monitoring and surveillance of fetomaternal conditions during intrapartum care by utilizing partograph appropriately will benefit to reduce obstructed labor and to prevent maternal death secondary to uterine rupture. 1, p. 117, 2017. 2009 Aug;116(9):1151-7. doi: 10.1111/j.1471-0528.2009.02190.x. Analyzing uterine rupture: A study from tertiary care centre of western Nepal, Use of the Partogram in the Bamenda Health District, North-West Region, Cameroon: A Cross-Sectional Study, The current management of vaginal birth after previous caesarean delivery, Prevention and Management of Postpartum Hemorrhage, Oxytocin Versus Misoprostol Plus Oxytocin in the Prevention of Postpartum Hemorrhage at a Semi-Urban Hospital in sub-Saharan Africa: A Retrospective Cohort Study, Factors Associated with Successful Vaginal Birth After a Primary Cesarean Section in Women with an Optimal Inter-Delivery Interval, Mode de dclenchement du travail et conduite du travail en cas dutrus cicatriciel. It occurs in approximately one in every 4000 births and, in most cases, during labor. If the mothers card (case note) missed dependent and other significant variables under study, then it will be excluded from the study; missed and tear cards were excluded. Twenty-one (15.6%) of the cases and 14 (5.2%) of the controls began their labor spontaneously. The possible explanation could be the differences in health care providers skills, severity of cases, time for securing hemostasis, the need for fertility and individualized decision-making, and protocols. BMC Res Notes DOI 10.1186/s13104-016-2295-9 CASE REPORT Management of uterine rupture: a case report and review of the literature Uterine Rupture Following Non-Operative Vaginal Delivery: A Close Save of Delayed Presentation With Hemoperitoneum to a Rural Tertiary Care Hospital. Among women with unscarred uterus, 14 presented with rupture and seven of these women were induced in hospital. Referral to a bereavement counselor, peer support group, or mental health professional may be advisable for management of grief and depression. There were 72000 live births in the study area with 194 cases of uterine rupture in five years data extraction from case notes of mothers. 80% of the cases were referred. Uterine rupture is a serious complication that can occur during vaginal birth. The risk of recurrence of PAS depends on the procedure used in the treatment performed and the number of treatments. Uterine rupture is a serious obstetrical condition associated with maternal mortality. Several studies have shown that the shorter the time between a cesarean delivery and a subsequent delivery, the higher the rate of uterine rupture. Enter the email address you signed up with and we'll email you a reset link. 2010;117:160815. Syed S, Noreen H, Kahloon LE, Chaudhri R. Uterine rupture associated with the use of intra-vaginal misoprostol during second-trimester pregnancy termination. However, uterine ruptures have also been known to occur in some . Eur J Obstet Gynecol Reprod Biol. Most uterine ruptures in resource-rich countries are associated with a trial of labor after cesarean birth (TOLAC). 2019 Oct;51(3):262-266. doi: 10.5152/eurasianjmed.2019.18341. Namazov A, Grin L, Volodarsky M, Anteby E, Gemer O. J Minim Invasive Gynecol. 2, pp. Misoprostol is a prostaglandin E1 analog that was originally used for the prevention and treatment of peptic ulcer disease [3]. 2009;116:106980. Provided by the Springer Nature SharedIt content-sharing initiative. The study identified referral from health facility, number of antenatal care visits, experienced obstructed labor, and birth weight of newborn to be significantly associated with uterine rupture. In 118 (87.4%) of the cases and 61 (22.6%) of the controls, labor was not followed by partograph. Mothers experiencing uterine rupture outcomes range from 3% to 12.3% vesicovaginal fistulas, 6.1% rectovaginal fistulas, and 16% bladder ruptures; of them were complication of management of ruptured uterus. I. S. J. Dhaifalah and H. Fingerova, Uterine rupture during pregnancy and delivery among women attending the Al-Tthawra Hospital in Sanaa City Yemen Republic, Biomedical Papers, vol. 2016;17(1):16. Total abdominal hysterectomy was done in 47 (34.8%) of the women, subtotal hysterectomy in 28 (20.74%), uterine repair with bilateral tubal ligation (BTL) in 26 (19.25%), and uterine repair without BTL in 34 (25.2%). Management is by treating read more , or fetal anomalies), Failure to recognize labor dystocia with excessive uterine contractions against a lower uterine restriction ring. Adanu RMK, McCarthy MY. Immediate intervention is important factor for successful management of uterine rupture. Lancet. Uterine rupture is rare. Spontaneous Rupture of Unscarred Uterus in a Term Primagravida with Lethal Skeletal Dysplasia Fetus (Thanatophoric dysplasia). 1, pp. Summary This chapter discusses the implications, diagnostic signs and management strategies for uterine rupture. Small uterine defects, incomplete ruptures, and silent uterine incision dehiscence were excluded. Justus Hofmeyr G, Say L, Metin Glmezoglu A. Uterine rupture (UR) is an . The rate of cesarean delivery fluctuates. She underwent a total abdominal hysterectomy and blood transfusion. JPMA J Pak Med Assoc. 2021 Nov;21(4):657-659. doi: 10.18295/squmj.4.2021.050. Patient was discharged on hematinics and vitamins. Article Traumatic uterine rupture may result from blunt abdominal traumas such as those that occur during motor vehicle accidents. The primary outcome was onset of labor which was defined as the presence of spontaneous regular and painful contractions that cause cervical dilation to at least 3 cm or prelabor rupture of membranes. 161202. An emergency positive culdocentesis was done. 1988;332:127780. Most cases of uterine rupture occur during labour following . Z. e0169304e0169308, 2017. This study also showed obstructed labor to be the strongest significant risk factor for uterine rupture. To this end, preventive strategies for obstructed labor require a multidisciplinary approach, as the factors are multifactorial. We presented a case of the woman at 34 weeks of gestation without apparent causes of SUUR. A. Al-Jufairi, A. K. Sandhu, and K. A. Al-Durazi, Risk factors of uterine rupture, Saudi medical journal, vol. However, blood transfusions were very common in studies done in Debre Markos (78%) and Pakistan (83%) [4, 21]. CAS Causes It happens more often in women who have had prior surgery on their womb, such as a cesarean section (c-section). To address this, uterine resection of localized disease has . She remained at the Department of Obstetrics and Gynecology for 5 more days and her hemoglobin level on discharge was 8.1g/dL. Our appreciation goes to Adigrat University for the financial support. This unmatched case control study is aimed at identifying the risk factors of uterine rupture and describing maternal and fetal outcomes of uterine rupture. 115, 2013. JPMA J Pak Med Assoc. The impact of a single-layer or double-layer closure on uterine rupture. It has recently increased, partly read more . Some have used other factors like maternal age, weight, inter-delivery period, estimated fetal weight and history of term/preterm cesarean section [4]. Copyright 2022 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. As soon as doctors even suspect uterine rupture, they must immediately . is probably the best way to measure LUS thickness: In a study conducted by Gotoh et al.35 , it was found that transabdominal ultrasound can detect scar defects located there may be incomplete uterine rupture at . We have used an unmatched case control study for frequency and ensured that cases and controls are not identical; however, they are comparable and share the same geographical and social backgrounds. 2002;16:2415. The biologic plausibility of this effect is related to the amount of time required for the uterine scar to heal completely and to nutritional Factors [20,21,22]. 2018 May 30;19:e00066. 2003 Jul 14;165(29):2894-5. The datasets used and/or analyzed during this study are available from the corresponding author on reasonable request. S. Gebre and A. Negassi, Risk factors for uterine rupture in Suhul General Hospital case control study, Electronic Journal of Biology, vol. in Rukungiri District in Uganda reported 30% use [18]. After calculating the previous five years admission of mothers in obstetric ward and knowing the total case load in each selected hospital, the sample size was allocated to the hospitals proportionally. In Ethiopia, the prevalence of uterine rupture ranges from 1.244% to 9.5% [4, 7, 8]. GEHE: Consultant Obstetrician and Gynecologist and Senior lecturer, Faculty of Health Sciences, University of Buea, Cameroon. In bivariate logistic regression, 20 variables showed association with uterine rupture at value of <0.2. We are reporting a case of uterine rupture for second trimester evacuation of a dead fetus that was managed at the department of Obstetrics and Gynecology, Douala General Hospital, Cameroon. 2022 Oct 6;15:551-556. doi: 10.2147/IMCRJ.S383195. The abdomen was distended and tender on palpation. Bivariate and multivariable logistic regression analysis result of significant variables (. The third is the perimetrium (outer surface). Method. Prual A, Bouvier-Colle M-H, de Bernis L, Breart G. Severe maternal morbidity from direct obstetric causes in West Africa: incidence and case fatality rates. 2, pp. With respect to the rupture location, 47 (34.8%) were anterior, 53 (39.25%) posterior, and 35 (25.92%) lateral. Eur J Obstet Gynecol Reprod Biol. Uterine rupture in the Netherlands: a nationwide population-based cohort study. Obstetrical complications like abdominal hysterectomy in 75 (55.6%) of mothers and excessive blood loss in 84 (57.8%) were additional untoward outcomes of uterine rupture. In another population-based study in the Netherlands, the incidence of uterine rupture was comparable with other Western countries. Am J Obstet Gynecol. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The cases were obtained from the labor and delivery ward, operating theatre registers, and from the patients' case files retrospectively. When physicians use labor-enhancing drugs, they must carefully monitor the fetus for signs of distress and be prepared to promptly respond if tachysystole occurs. Having a care team that's prepared for emergencies can prevent these outcomes from happening. J Med Ultrasound [serial online] 2018 [cited 2022 Dec 3];26:59-61. . 114, no. Another study in Ethiopia reported a prevalence of 0.9% [10]. . Uterine rupture is a complication of labour, where the muscle layer of the uterus (myometrium) ruptures. This type of practice should be discouraged because it is associated with obstetric and neonatal complications such as uterine rupture [15]. Health care providers should encourage mothers to complete the recommended four visits as these contribute to full risk assessment and screening opportunities for the mom and the fetus. Bookshelf Fetal condition contraindicating expectant management including chorioamnionitis, placental abruption, intrauterine fetal demise, non-reassuring fetal heart rate at the time of randomization; Cervical dilation > 5 cm; Iatrogenic rupture caused by amniocentesis or trophoblast biopsy; Major fetal anomaly Introduction - Uterine Rupture Definition Uterine rupture is full-thickness loss of integrity of the uterine wall and visceral peritoneum. Egbe, T.O., Halle-Ekane, G.E., Tchente, C.N. In the short-term plan, assessing and identifying high-risk mothers are mandatory. Google Scholar. With the advent of misoprostol, a prostaglandin E1 analog is cheap and accessible to most health facilities in Cameroon and most countries in sub-Saharan Africa. 2010;115:10036. 4 the following primary interventions should occur immediately and simultaneously, for any delay in management can result in 10, pp. management immediate delivery in most cases, total abdominal hysterectomy is the . Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, Fat DM, Boerma T, Temmerman M, Mathers C, Say L. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Management of uterine rupture: a case report and review of the literature. 3, no. Obstet Gynecol. 4, pp. A. M. Abasiattai, A. J. Umoiyoho, N. M. Utuk, E. C. Inyang-Etoh, and O. P. Asuquo, Emergency peripartum hysterectomy in a tertiary hospital in southern Nigeria, The Pan African Medical Journal, vol. Women with a classical incision that run vertically on the corpus uteri run a higher risk of uterine rupture than those with a low uterine segment transverse incision [23]. Veena P, Habeebullah S, Chaturvedula L. A review of 93 cases of ruptured uterus over a period of 2years in a tertiary care hospital in South India. reported that uterine rupture in the majority of cases is associated with poor and traumatic obstetric practice [31]. Graham D, Agrawal N, Roth S. Prevention of NSAID-induced gastric ulcer with misoprostol: multicentre, double-blind, placebo-controlled trial. This is an open access article distributed under the. The documented immediate causes of maternal deaths were hypovolemic shock [8], septic shock [2], and other causes like pulmonary edema [1] and acute renal failure [1]. Prompt diagnosis is necessary to treat this complication given its quick onset and progression, and prevent potential life-threatening complications to mother and fetus. Bivariate and multivariate logistic regression with 95% confidence interval was used to identify the determinants of uterine rupture. How is uterine rupture treated? Springer; 2014. pp. There is evidence to suggest that overall success of a VBAC ranges from 72-76 % [2], with factors that can increase or decrease the chances of success. Unable to load your collection due to an error, Unable to load your delegates due to an error, Posterior uterine rupture extending from the fundus to the isthmus and affecting the left broad ligament and uterine vessels (See. https://doi.org/10.1186/s13104-016-2295-9, DOI: https://doi.org/10.1186/s13104-016-2295-9. This may have been the appropriate method for our patient although she was at no particular risk of uterine rupture. Uterine rupture is a serious obstetrical condition associated with maternal mortality. A retrospective hospital-based unmatched case control study design was implemented with 135 cases of women with uterine rupture and 270 controls of women without uterine rupture. -. The patients stayed between one and 31 days in the hospital with a mean of 10.95.9 days. The reason might be failing of detecting fetal macrosomia during antenatal care which contributes to fetal-pelvic disproportion and may lead to prolonged and neglected obstructed labor. California Privacy Statement, - Insert a Foley urinary catheter. Ltd., Swathi Bhat, International Journal of Reproduction, Contraception, Obstetrics and Gynecology, Indonesian Journal of Obstetrics and Gynecology, Gynecology and Obstetrics Research - Open Journal, International Journal of Maternal and Child Health and AIDS (IJMA), Journal of South Asian Federation of Obstetrics and Gynaecology, The role of maternal body mass index in outcomes of vaginal births after cesarean, Serial Membrane Sweeping at Term in Planned Vaginal Birth After Cesarean: A Randomized Controlled Trial. This assertion was added to the abstract concluding session. The greatest risk factor for uterine rupture is a previous Caesarean section - monitoring and recognition is a key principle of a VBAC delivery. and transmitted securely. Five (3.7%) of the cases and 12 (4.4%) of the controls were instrument deliveries. 150, no. It can occur during late pregnancy or active labor. The mothers referred from remote health institutions were 7.29 times more likely to develop uterine rupture compared to those who did not have referrals (AOR 7.29; 95% CI: 2.7, 19.68). Patients with a classical hysterotomy are likely to rupture during pregnancy and studies have shown that they should be delivered by 3637weeks gestation. SURGICAL MANAGEMENT:Caesarean Section LaparotomyHysterectomy Diagnosis of uterine rupture is confirmed by laparotomy. This study is aimed at addressing determinant factors of uterine rupture and its adverse maternal and fetal management outcomes in public hospitals of Tigrai. 2016;2:10211. 2, 2017. This is often the case in the sense of unsupervised or undersupervised labor in poorly equipped settings, failing detection of prolonged labor by partograph, inadequacy of skilled care providers to detect and give timely, vigilant management for fetal-pelvic disproportion, and overlooked obstructed labor which may lead to rupture due to exhaustion of uterine layers integrity. 13, no. A short summary of this paper. o [teenager OR adolescent ]. By using this website, you agree to our Google Scholar. Request PDF | Management of uterine rupture during molar pregnancy | Gestational trophoblastic disease (GTD) is rare and encompasses several clinicopathologic forms from pre-malignant to malignant . 2005;112:12218. Finally, uterine rupture is a complication that can be eliminated if best obstetric practice is ensured. Accessibility The https:// ensures that you are connecting to the Vaginal delivery after one cesarean section. Usually, destruction to the uterus is not correctable and the outcome is often a hysterectomy [1]. The study by Nguefack et al. 51, no. The odds ratio was with their 95% confidence interval; two-tailed value was computed to declare the level of significance. For those who visited antenatal care, 49 (43.8%) of the cases and 170 (64.45%) of the controls had four or more visits. . Multifetal (multiple) pregnancy occurs in up to 1 of 30 deliveries. 2015;187:804. This frequency increases with advancing gestational age and when performed by less experienced providers (ACOG, 2019). Passcode Required The content you are trying to view is protected by a passcode. Tayade S, Chadha A, Khandelwal S, Makhija N, Tilva H, Madaan S. Cureus. The incidence of uterine rupture in Africa ranges from 0.5% to 9.5% of births [47]. Bujold E, Gauthier RJ. The proportion of mothers who experience obstructed labor among the case group was 80 (59.3%) and 28 (10.4%) in the control group. A scarred uterus is not a necessary pre-condition for uterine rupture. uterine rupture complete transection of the uterus from the endometrium to the serosa partial or complete prior scar - 40%; unscarred - 60% warning signs sharp abdominal pain, foetal distress, unable to palpate presenting part vaginally, maternal shock, abnormal contouring of abdomen. All these factors have thus not been collectively included in various screening tools. treatment guidelines for the management of uterine inversion are based on the best available evidence from case reports, small retrospective case series describing effective treatment options, and expert opinion. To attain this objective, use of misoprostol in primary health facilities should be stopped or proper management of the medication instituted. Learn more about the MSD Manuals and our commitment to, Abnormalities and Complications of Labor and Delivery. She has a history of missed abortion at 19 weeks gestation and an attempt to evacuate the uterus with misoprostol that led to uterine rupture. Indian patients have not had a large representation in former studies. 2005;193:165662. 37 Full PDFs related to this paper. T. L. Dadi and T. E. Yarinbab, Estimates of uterine rupture bad outcomes using propensity score and determinants of uterine rupture in Mizan-Tepi University Teaching Hospital: case control study, Journal of pregnancy, vol. Introduction: Uterine rupture remains one of the top catastrophic events in the field of Obstetrics. Background: Abstract: A uterine rupture is an obstetric catastrophe accounting for as many as 9.3% of maternal deaths1. More than half (59.3%) of the cases had obstructed labor. Uterine rupture. While there is increased maternal and perinatal morbidity associated with the failure of trial of vaginal birth after cesarean section (VBAC), a successful trial of VBAC reduces the risk of complications in future pregnancies, associated with a repeat cesarean section. In line with a study conducted in Debre Markos (Ethiopia), France, and Denmark [4, 18, 19], this finding found that those who had a birth weight of four and above kilograms had high odds of developing uterine rupture. It is a potentially life threatening condition for both the mother and/or the baby and requires immediate surgical intervention. Direct complication of ruptured uterus includes 59.8% to 88.8% which incur severe blood loss; and 14% to 51.8% undergo total abdominal hysterectomy. The uterine rupture was a dependent variable. In the developing world, uterine rupture can have devastating maternal and/or fetal outcomes due to delayed recognition and/or intervention. Knowing the risk factors of uterine rupture will potentially assist women, providers, and health systems to take actions on each factor to decrease maternal as well as perinatal morbidity and mortality related to uterine rupture. A. Pinton, E. Boudier, A. Joal et al., Risk factors and clinical presentation of uterine rupture in the unscarred uterus: a case control study, Journal of Pregnancy and Child Health, vol. Maternal morbidity and mortality has been a major World Health Organization concern over the years, especially in sub-Saharan Africa. Among patients in the reproductive age who have not completed their desired family size, such a procedure could be unacceptable. [Uterine rupture during second trimester abortion induced with misoprostol]. Although risk factors of uterine rupture are context specific, there is lack of clarity in our context towards the contributing factors and untoward outcomes of uterine rupture. After surgery, additional blood, and fluid replacement is continued along with antibiotic theory. 2015;130:1236. Forty-eight (11.9%) of the cases had postoperative hemoglobin value (HGB) of <7g per dl; 34 (8.4%) cases have HGB value of 7-11g/dl, and 53 (13.1%) cases have postoperative HGB value of >11g/dl. Teguete I, Dolo A, Sissoko A, Thera A, Traore M, Djire MY, Mounkoro N, Dolo T, Traore Y. Berghella V, Airoldi J, O'Neill AM, Einhorn K, Hoffman M. BJOG. Egbe O Thomas. In a study of 32 080 deliveries in JIPMER (India), 93 (0.28%) women had a ruptured uterus. Schematic presentation of sampling technique to identify determinants of uterine rupture and management outcomes among mothers who give birth in public hospitals of Tigray, 2018/2019. Uterine rupture was defined as tearing of the uterine wall either partially or completely during pregnancy and labor, diagnosed clinically and later confirmed at laparotomy by the attending physician. Charts (case notes) of women without uterine rupture (control) found after the cases (since cases and controls should be comparable regardless of the presence of the disease of interest, we enrolled controls who were admitted following the cases to avoid seasonal impact on transportation from rural areas and other parameters) were selected randomly and enrolled. Sample size was calculated using Epi-info Version 7 based on the following assumptions: 95% level of confidence, 80% power, taking two to one ratio of controls to case (2:1). 2011;35(5):25761. Use to remove results with certain terms factor for uterine rupture, and this is similar to the findings of reported research (19). 7, no. doi:10.1016/0020-7292(94)90405-7. In the particular case of Mezam Division, Cameroon, the leading causes are Postpartum Hemorrhage (30.43%), unsafe abortion (26.09%), and pregnancy-induced hypertension (14.49%) [1, 2]. ; Contact Us Have a question, idea, or some feedback? Uterine perforation at the time of vacuum aspiration is a rare but potentially serious complication, estimated to occur in between 0.1-3 per 1,000 induced abortion procedures (Kerns & Steinauer, 2013; Pridmore & Chambers, 1999). Finally, health facility, number of antenatal visits, experience of obstructed labor, and birth weight of newborn were found to be statistically associated with uterine rupture. 15, no. o [ pediatric abdominal pain ] Furthermore, a single-layer closure of the previous lower segment incision is the most influential factor and is associated with a fourfold increase in the risk of uterine rupture compared with a double-layer closure [25]. This paper reports uterine rupture with severe hypovolemic shock managed at the Douala General Hospital, Cameroon. 2000;78:593602. The proportion of control with educational level of primary school is 67% and the proportion of case with educational level of primary school is 80.63%, with the odds ratio of primary school educated women as 2.05 times more likely to develop uterine rupture [13]. Acta Obstetricia et Gynecologica Scandinavica, IP Innovative Publication Pvt. 2009;9(S2):2734. This study would identify determinant factors of uterine rupture and its management outcomes among mothers who gave birth in public hospitals in Tigrai region, North Ethiopia. Risk factors for such ruptures may include previous uterine scar, short birth spacing, and use of uterotonic (oxytocin/prostaglandin) medications [9, 29, 30]. Sixteen (11.9%) of the cases and 1 (0.4%) of the controls had more than eighteen hours of labor. 2016;15:115. D. L. A. Thisted, L. H. Mortensen, and L. Krebs, Uterine rupture without previous caesarean delivery: a population-based cohort study, European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. For example, during rainy seasons, women in rural areas do not come to seek obstetric care at a higher facility due to the unavailability of transportation. There was a fluid thrill, shifting dullness and mild vaginal bleeding. Although a limited number of successful . Egbe et al. Ekane GEH, Obinchemti TE, Tchente CN, Fokunang LK, Njamen TN, Bechem NN, Njie MM, Latum D. Attainment of the fifth millennium development goal: utopia or reality based on trends in maternal mortality in 12 years in two regional hospitals in fako division, Cameroon? Does Misoprostol for Induction of Labor Increase the Risk of Uterine Rupture? Download Download PDF. We would like to recognize Tigray Regional Health Bureau for the invaluable support. A retrospective study. Google Scholar. 2014;4:771781. 1, pp. HHS Vulnerability Disclosure, Help M. Kaczmarczyk, P. Sparn, P. Terry, and S. Cnattingius, Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population-based study of successive pregnancies in Sweden, BJOG: An International Journal of Obstetrics & Gynaecology, vol. doi: 10.7759/cureus.21076. Posterior uterine rupture extending from, Posterior uterine rupture extending from the fundus to the isthmus and affecting the, Posterior wall uterine rupture extending, Posterior wall uterine rupture extending from the fundus to the isthmus, MeSH Maternal death, stillbirth, hysterectomy, and excessive blood loss were adverse outcomes of uterine rupture. Horse owners and managers can help by assisting with dystocia or quickly seeking veterinary help, especially in older mares. 5, p. 2, 2016. In some cases, the cyst can break open (rupture). One hundred and eight (80%) and 67 (24.8%) of the mothers were referred from remote health facilities aligned with cases and controls, respectively (Table 1). An early diagnosis of an interstitial pregnancy diagnosis is extremely important for timely management but challenging because of difficult ultrasound aspects. What is management of a ruptured ovarian cyst? What is a uterine scar rupture? A uterine rupture is a complete division of all three layers of the uterus: the endometrium (inner epithelial layer), myometrium (smooth muscle layer), and perimetrium (serosal outer surface). P. K. Mukasa, J. Kabakyenga, J. K. Senkungu, J. Ngonzi, M. Kyalimpa, and V. J. Roosmalen, Uterine rupture in a teaching hospital in Mbarara, western Uganda, unmatched case- control study, Reproductive health, vol. Open J Obstet Gynecol. 8, 2015. It is a rare problem that can happen when giving birth. Despite strengthening the health care system and provision of basic and comprehensive emergency obstetric care, Ethiopian women continue to face devastating maternal and fetal outcomes, particularly in the study area [14]. Uterine rupture and maternal death from hemorrhage is a preventable complication of childbirth in sub-Saharan Africa. Obstetric conditions of cases and controls who gave birth at public hospitals of Tigray, North Ethiopia. Laparoscopic Management of Uterine Rupture After Early Second-Trimester Medical Abortion in a Patient With a Prior Cesarean Section. Cases were enrolled consecutively from case notes of women who gave birth from 1/9/2015 to 30/6/2019, while charts (case note) of women without uterine rupture found following the cases were selected randomly and enrolled. In conclusion, this study found that referrals from remote health institutions, antenatal care visit once, obstructed labor, and birth weight of newborns were significant determinants of uterine rupture. Halperin ME, Moore DC, Hannah WJ. Depending on the nature of the rupture and the condition of the patient, the uterus may be either repaired or removed (cesarean hysterectomy). 1500mL of blood was secured from the laboratory and she underwent an emergency laparotomy with a sub-umbilical mid-line incision. Int J Gynecol Obstet. - Insert 2 IV lines (16-18G catheter) and administer Ringer lactate. Indian J Crit Care Med. Would you like email updates of new search results? This condition is caused by gross uterine distention or uterine scarring; patients who have had a. cesarean delivery. Result. All rights reserved. Her post-operative stay in hospital was uneventful. This fact should be considered when counseling women for VBAC [13]. Studies have reported that the incidence rate of uterine rupture in women who attempt VBAC was 9.8 per 1000 and prior vaginal delivery was associated with a lower risk of uterine rupture (adjusted odds ratio [OR] 0.40, 95% CI 0.200.81) [14]. Grand multiparity (7 deliveries in obstetric history) accounted for 12.4% (59/475) of all uterine ruptures while short inter-pregnancy interval has been observed in 12.0% of all uterine ruptures (57/475) [28]. Int J Gynecol Obstet. Laparoscopic cornuostomy for the surgical management of interstitial pregnancy, as opposed to cornual wedge resection, should be considered, particularly in stable patients with intact ectopic pregnancy. Given that uterine rupture is rare, we have enrolled charts of women who have met the inclusion criteria until the total sample size was attained (Figure 1). Egbe T, Dingana T, Halle-Ekane G, Atashili J, Nasah B. Determinants of maternal mortality in Mezam division in the north west region of Cameroon: a community-based case control study. Reports from the study in Mali show that uterine rupture occurred in 87.4% (415/475) of cases in an unscarred uterus vs 12.6% (60/475) in a scarred uterus. Nayki U, Taner CE, Mizrak T, Nayki C, Derin G. Fetal Diagn Ther. 3538, 2010. Although all these factors have been shown to influence VBAC trail outcome in some studies , they have not achieved statistical significance in other studies. . Other methods of controlling bleeding during a uterine rupture, after the baby has been delivered, include: Abdominal packing- sponges and towels should be packed into the uterus and abdomen to control bleeding via pressure Uterine artery ligation or internal iliac artery ligation Other methods of hemostasis like flowseal in a case fatality study of maternal morbidity from 23 West African countries and 20326 pregnant women between 32 and 36weeks amenorrhea during delivery and up to 60days post partum reported that uterine rupture accounted for 0.12 per 100 live births [8]. Uterine repair without tubal ligation leaves a uterus that is more prone to repeat rupture while uterine repair with bilateral tubal ligation (BTL) or (sub)total hysterectomy predispose survivors to psychosocial problems like marital disharmony. The survival of patients after uterine rupture depends on the time interval between rupture and intervention and the availability of blood products for transfusion. Uterine rupture during second trimester abortion with misoprostol. Lancet. 3.3.3 Management See also algorithm. Bujold E, Bujold C, Hamilton EF, Harel F, Gauthier RJ. During surgery, we found that there was hemoperitoneum estimated at about 2500mL and the uterus was completely torn posteriorly from the fundus to the isthmus and extending to the left broad ligament with involvement of the ascending branch of the uterine artery (Figs. 1528, 2014. -, Marret H, Simon E, Beucher G, Dreyfus M, Gaudineau A, Vayssire C, Lesavre M, Pluchon M, Winer N, Fernandez H, Aubert J. Overview and expert assessment of off-label use of misoprostol in obstetrics and gynaecology: review and report by the Collge national des gyncologues obsttriciens franais. PubMed Thomas Obinchemti Egbe. Knowing the determinants of uterine rupture helps prevent the occurrence of a problem in pregnant women, which reduces maternal morbidity and mortality, and would have a tremendous help in identifying the best optional strategies in our current practices. Uterine rupture occurs most often along healed scar lines in women who have had prior cesarean deliveries Cesarean Delivery Cesarean delivery is surgical delivery by incision into the uterus. 4, pp. The survival of patients after uterine rupture. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. G. Astatikie, M. A. Limenih, and M. Kebede, Maternal and fetal outcomes of uterine rupture and factors associated with maternal death secondary to uterine rupture, BMC pregnancy and childbirth, vol. 1998;28:14652. Int Med Case Rep J. 2007;110:107582. G. Girmay, T. Gultie, G. Gebremichael, B. Afework, and G. Temesgen, Determinants of uterine rupture among mothers who gave birth in Jinka and Arba Minch general hospitals, institution-based casecontrol study, southern Ethiopia, Ethiopia, 2019, Women's Health, vol. complication that is life-threatening for the mother and the baby. Studies in Bangladesh and India report the use of oxytocin by unqualified allopathic practitioners (UAP) providing health services to the poor [15]. Graham D, Agrawal N, Roth S. Prevention of NSAID-induced gastric ulcer with misoprostol: multicentre, double-blind, placebo-controlled trial. Please enter the related passcode in order to view this content: Invalid passcode Submit TOE: Consultant Obstetrician and Gynecologist and Senior lecturer, Faculty of Health Sciences, University of Buea, Cameroon. Mothers who had only one prenatal care visit were 2.85 times more likely to develop uterine rupture compared to those who had four visits or more antenatal care visits with AOR 2.85 (95% CI: 1.02, 7.94). Gessessew A, Melese MM. Conclusion. Cite this article. A. Turgut, A. Ozler, M. S. Evsen et al., Uterine rupture revisited: predisposing factors, clinical features, management and outcomes from a tertiary care center in Turkey, Pakistan Journal of Medical Sciences, vol. The cases were obtained from the labor and delivery ward, operating theatre registers, and from the patients case files retrospectively. Hussein AI, Omar AA, Hassan HA, Kassim MM, Yusuf AA, Osman AA. 2016;15:115. o [ abdominal pain pediatric ] The diagnostic signs depend on the site, extent and timing of the uterine rupture. It was then concluded that the strongest association of ruptured uterus was with previous scarred uterus, multiparity and<18months duration from the last cesarean section [26]. Labor and delivery distributions of cases and controls who gave birth at public hospitals of Tigrai, North Ethiopia. Ekane GEH, Obinchemti TE, Tchente CN, Fokunang LK, Njamen TN, Bechem NN, Njie MM, Latum D. Attainment of the fifth millennium development goal: utopia or reality based on trends in maternal mortality in 12 years in two regional hospitals in fako division, Cameroon? 4, p. 222, 2016. Mrs. MM aged 25 years, G3P2012, of the Bamileke tribe in Cameroon was admitted to our Department in hypovolemic shock BP = 70/40 mmHg, pulse 120 beats per minute, with altered consciousness (Glasgow Coma Scale = 13). Uterine rupture is spontaneous tearing of the uterus that may result in the fetus being expelled into the peritoneal cavity. Landon Mark B, Lynch Courtney D. Optimal timing and mode of delivery after cesarean with previous classical incision or myomectomy: a review of the data. Marret H, Simon E, Beucher G, Dreyfus M, Gaudineau A, Vayssire C, Lesavre M, Pluchon M, Winer N, Fernandez H, Aubert J. Overview and expert assessment of off-label use of misoprostol in obstetrics and gynaecology: review and report by the Collge national des gyncologues obsttriciens franais. Federal government websites often end in .gov or .mil. These providers are close to homes, willing to make house calls, trusted by the community, have longer working hours and offer services at lower costs. 17, 2013. Cards of mothers, who gave birth from 1/9/2015 to 30/6/2019 in selected public hospitals of Tigrai, were retrieved. This site needs JavaScript to work properly. The parameters influencing TOL available on admission from history and examination can collectively be evaluated to help guide the clinician and estimate the probability of success of TOL after previous one cesarean section. -, Syed S, Noreen H, Kahloon LE, Chaudhri R. Uterine rupture associated with the use of intra-vaginal misoprostol during second-trimester pregnancy termination. Purpose Stillbirth is one of the most common adverse pregnancy outcomes, occurring in 1 in 160 deliveries in the United States. Stamilio DM, DeFranco E, Par E, Odibo AO, Peipert JF, Allsworth JE, Stevens E, Macones GA. Short interpregnancy interval: risk of uterine rupture and complications of vaginal birth after cesarean delivery. From 135 mothers who develop uterine rupture, 13 (9.6%) mothers died and 101 (74.8%) fetuses were stillborn. Symptoms and Causes. The odds of developing uterine rupture for women experiencing obstructed labor were 13.33 times higher compared to those who had no experience with obstructed labor (AOR 13.33; 95% CI: 4.23, 42.05). Egbe et al. in Douala reported that the prevalence of uterine rupture was 0.4% (1:249) [9]. Although much attention is paid to scar rupture associated with uterotonic agents, 13% of ruptures occurred in unscarred uteri and 72% occurred during spontaneous labour [27]. The most important factors in the treatment and management of uterine rupture are (a) timely recognition and a presumptive diagnosis of the rupture; and (b) immediate intervention to deliver the baby as quickly as possible. Majority of the scoring systems have used indication of previous cesarean, Bishops score and history of VBAC in their screening tools. The possible explanations could be due to the absence of antenatal care follow-up, distances hindering referral and increasing time to care, contribution of delays from family, and delays in health institutions. eCollection 2018 Jul. Q. QAZI, Z. AKHTAR, K. KHAN, and A. H. KHAN, Woman health; uterus rupture, its complications and management in Teaching Hospital bannu, pakistan, Pakistan Mdica - a Journal of Clinical Medicine, vol. CNT: Consultant Obstetrician and Gynecologist and Senior Lecturer, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon JEN: Head Nurse operating theatre, Douala General Hospital EBP: Professor of Obstetrics and Gynecology, University of Yaounde 1, Cameroon. Turner et al. The link you have selected will take you to a third-party website. CAS You can download the paper by clicking the button above. Google Scholar. We thank the staff of the Douala General Hospital for their assistance in the management of the case. Uterine prolapse is a relatively uncommon complication of parturition, occurring infrequently in cats and rarely in dogs. doi: 10.1016/j.ejogrb.2015.01.018. Obstet Gynecol. CAS Vaginal birth after cesarean delivery in the West African setting. Among those who had uterine rupture, 48 (11.9%) of the mothers had received blood transfusion. Among those who had uterine rupture, 48 (11.9%) of the mothers received blood transfusions. 495527. Our patient was administered an unknown dosage of misoprostol that resulted in the rupture. One hundred and thirty (96.3%) of the cases and 267 (98.9%) of the controls have Tigrai ethnicity, eighty (59.3%) of the cases and 138 (51.1%) of the controls were housewives, and 109 (80.7%) of the cases and 249 (92.2%) of the controls were Orthodox Tewahedo believers. Am J Obstet Gynecol. Epub 2021 Nov 25. Prual et al. Uterine rupture is a complication that can be eliminated under conditions of best obstetric practice. Upper-segment caesarean section scar has a higher risk of uterine rupture compared with lower-segment caesarean section (LSCS) scar. This can result in timely referral of patients unlikely to have a successful VBAC, European Clinics in Obstetrics and Gynaecology. Health personnel are almost forgetting the good practice of using the partogram for labor follow-up. Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) dedicated to using leading-edge science to save and improve lives around the world. Though fetal macrosomia is diagnosed retrospectively after birth, antenatal surveillance is mandatory. Uterine rupture in Mekelle, northern Ethiopia, between 2009 and 2013. Four hundred and five mothers cards (case notes) were reviewed based on the sampling of 135 cases and 270 controls. Adjusted odds ratios range from 2.5 to 3 for an increased rate of uterine rupture in the women with less time between deliveries. B. Lindtjrn, D. Mitiku, Z. Zidda, and Y. Yaya, Reducing maternal deaths in Ethiopia: results of an intervention programme in southwest Ethiopia, PLoS One, vol. low-transverse cesarean births show a trend toward increased risk of rupture compared with a single prior cesarean . Uterine rupture is spontaneous tearing of the uterus that may result in the fetus being expelled into the peritoneal cavity. 22, no. Case presentation: Uterine rupture is a. pregnancy. OBJECTIVE: To estimate the effect of serial membrane sweeping on the onset of labor in women who planned vaginal birth after cesarean (VBAC). 3. Despite strengthening the health care system and providing basic and comprehensive emergency obstetric care closer to the communities, uterine rupture continues to produce devastating maternal and fetal outcomes. This paper reports uterine rupture with severe hypovolemic shock managed at the Douala General Hospital, Cameroon. Many of the risk of uterine rupture in women with LUS experts suggest that a combination of both approaches measurement < 2.3 mm. Lancet. , MD, Children's Hospital of Philadelphia. 2015;187:8084. 2002;186(6):132630. Further prospective studies are needed to identify predictors of uterine rupture and predictors with untoward management outcomes. At the time of the uterine evacuation, the pregnancy was 24weeks 2days gestation calculated from her last menstrual period. 151155, 2015. in 2016 [ 9 ]. BMC Research Notes The retrospective nature of the study might miss some sociodemographic and socioeconomic variables despite vigorous tracing in the case file, operation room theatre registration, delivery registration books and neonatal cards, and case file. Int J Gynecol Obstet. She underwent a total abdominal hysterectomy and blood transfusion. Referrals from remote health institutions, once-visited antenatal care, obstructed labor, and birth weight of newborns greater than four kilograms were significant determinants of uterine rupture. statement and in Burkina Faso reported 46.6% partogram use [17] while Ogwang et al. Other predisposing factors include congenital uterine abnormalities, trauma, and other uterine surgical procedures such as myomectomies or open maternal-fetal surgery. Though determinant factors for uterine rupture differ across localities due to differences in sociodemographic status, readiness and ease of access to skilled birth attendants, and health system efficacy, previous studies have found that labor induction, grand multiparity, lack of ANC follow-up, history of previous caesarian section (C/S), prolonged labor, obstructed labor, lack of partograph utilization, and instrumental delivery were significantly associated with uterine rupture [2, 5, 8, 1013]. Use OR to account for alternate terms 1988;95:9906. Egbe TO, Ncham EN, Takang W, Egbe EN, Halle-Ekane GE. Among cases, it was found that 29 (21.5%) of newborn birth weights were four kilograms as opposed to 18 (6.7%) in the control group (Table 3). The dataset(s) supporting the conclusions of this article could be obtained from the authors on request by the editors. We do not control or have responsibility for the content of any third-party site. This may be due to delays in reaching health facilities due to long distances and poor road networks; many mothers end up with uterine rupture. She has a history of missed abortion at 19weeks gestation diagnosed by ultrasonography 3 days prior to admission at our Department, and an attempt to evacuate the uterus with an unknown dose of misoprostol before she went into shock. Determining factors of cesarean delivery trends in developing countries: lessons from point G National Hospital (Bamako-Mali). The magnitude of fetal mortality is very high with 1.7% to 7% of babies surviving after uterine rupture; 93% to 98.3% of them were stillbirths [4, 5, 7]. CARE guidelines/methodology were adhered to in the preparation of this manuscript. In the five years survey, there were 72000 deliveries without uterine rupture (control) and 194 cases in Adwa General Hospital (, ), Ayder Referral Hospital (, ), Suhul Shire General Hospital (, ), Lemlem Karl Hospital (, ), and Adigrat General Hospital (, ). The increasing number of women with a previous cesarean section and the decreasing rates of VBAC seem to suggest that cesarean sections are gaining more currency. Maternal morbidity and mortality has been a major World Health Organization concern over the years, especially in sub-Saharan Africa. Authorization was obtained from the Director of the Douala General Hospital and Consent was obtained from the patient to report the case. How Long is the Safest InterDelivery Interval in Women with Previous History of Cesarean Delivery? Mrs. MM aged 25years, G3P2012, of the Bamileke tribe in Cameroon was admitted to our Department in hypovolemic shock BP=70/40mmHg, pulse 120 beats per minute with altered consciousness (Glasgow Coma Score=13). My Research and Language Selection Sign into My Research Create My Research Account English; Help and support. Regarding the mode of management, uterine repair only (42.0%) was the commonest surgery done in the patients, followed by hysterectomy (37.0%) and repair with bilateral tubal ligation(21.0%). Google Scholar. We carried out a total abdominal hysterectomy and peritoneal toileting. GEHE, CNT and EBP took part in the management of the patient. Maternal mortality, one of the major concerns of the World Health Organization, remains high in most of sub-Saharan Africa [1, 2]. Uterine rupture is a complication that can be eliminated under conditions of best obstetric practice and use of misoprostol in primary health facilities should be stopped or proper management of the medication instituted. Bull World Health Org. Correspondence to Conclusion: Health Sci Dis. The fetus was found in the peritoneal cavity completely macerated. If women who have had a prior cesarean delivery wish to try vaginal delivery, prostaglandins should not be used because they increase risk of uterine rupture. This case stresses the importance of good obstetric practice and the need for qualified medical and paramedical staff. Here, we present 2 cases of non-surgical management of UR following vaginal delivery, which were both treated by uterine transarterial embolization (UAE). Case Rep Womens Health. Female Reproductive Organs Copyright 2002 Nucleus Communications, Inc. All rights reserved. A ruptured cyst may be managed in several ways: You may just need to keep track of your symptoms. 60, pp. Charts (case note) of women diagnosed with uterine rupture who met the criteria were enrolled consecutively, while charts (case note) of women without uterine rupture (control) found following the cases were selected randomly and enrolled. Descriptive statistics were presented. This study identified an association between referral status and uterine rupture. BMC Res Notes 9, 492 (2016). If a uterine rupture causes major blood loss, surgeons may need to remove a woman's uterus to control her bleeding. 6, no. 3, pp. However, others suggest a planned cesarean delivery at 38weeks gestation [24]. See this image and copyright information in PMC. Am J Obstet Gynecol. 2011;61:399401. This patient presented a 2500 mL hemoperitoneum. Up to 30% of deliveries in the US are cesarean. We have used 5% contingency for the incomplete and missed patients cards, while our final complete records for both cases and controls were 405. The survival of patients after uterine rupture depends on the time interval between rupture and intervention, and the availability of blood products for transfusion. All the authors proofread the final manuscript. S. Saeed, A. Ahmad, and N. Akhtar, Uterine rupture; four years experience on seventy four cases in secondary care hospital, Professional Medical Journal, vol. She has a history of missed abortion at 19weeks gestation and an attempt to evacuate the uterus with misoprostol that led to uterine rupture. You may need to take pain medicine. 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