Talat J. Hassan ( Pakistan Medical Research Council, Research Centre, Jinnah Postgraduate Medical Centre, Karachi. )
Razia Korejo ( Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi. )
Sadiqua N. Jafary ( Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi. )
Of 48,519 deliveries conducted at Jinnah Postgraduate Medical Centre (JPMC) over 7 years (January, 1986to December, 1992), 257 were of ruptured uterus, giving a rate of one in 189 deliveries. Main cause of rupture was obstructed labour. Maternal mortality was 3.9% and foetal mortality 88% in cases admitted with uterine rupture and 17.6% in rupture occurring within the hospital (JPMA 43: 172, 1993).
Reported incidence of uterine rupture varies between 1 in 93 to 1 in 2,500 deliveries1. It is a serious obstetrical problem and carries a high maternal and foetal mortality especially in developing countries like Zambia2, Uganda3 and India4. In Pakistan the reported frequency from Peshawar5 and Lahore6 is 1 per 46 and 1 per 920 deliveries respectively. This study was undertaken to determine the contributing factors and its frequency in Karachi.
Patients and Methods
All pregnant females admitted to the department of obstetrics and gynaecology of Jinnah Postgraduate Medical Centre (JPMC) with ruptured uterus over a period of 7 years (January, 1986 to December, 1992) or those who developed this complication in the hospital during this period were studied. Of 264 cases, diagnosis was clinical in 7 cases (5 were brought dead and 2 died soon after admission) so they were excluded. Detailed history including obstetrical details of present pregnancy, labour, medication, obstetric examination by medical and paramedical personnel were recorded on a specially designed proforma in the remaining 257 cases. Complete physical and obstetrical examination and determination of patient’s position on proforma were done at the time of admission. Mothers having no clinical sign of uterine rupture at the time of admission asked delivering within 6-8 hours and rupture appearing fresh on laparotomy were taken as those occurring within the hospital. Ruptures extending through uterine serosa or peritoneum at laparotomy were considered to be complete ruptures while those falling short of these were classified as incomplete.
A significant difference is seen in foetal mortality among cases admitted with uterine rupture (74.8%) and those developing the complication within the hospital (16.7%). This is probably due to timely diagnosis and appropriate and aggressive management of the complication in cases admitted relatively early, i.e., before developing the complication which most likely was then inevitable. Remarkable difference is also seen in maternal mortality and morbidity in the two groups (Table III) showing that avaiability of expert medical facilities helps the patient at whatever stage it is sought. If it is made use of early in pregnancy a number of obstetrical comlication, including the one under discussion, may be avoided. A proper ante-natal care which includes careful obstetric history may suggest the presence or absence of CPD and equally careful systematic clinical pelvimetory will give the size and configuration of the pelvis which is very important for intelligent evaluation of CPD: the leading cause of obstructed labour in our cases. Sequelae of obstructed labour are many and varied, most dangerous of which is uterine rupture, which carries a high maternal and foetal mortality.
1. Masleh, R., Sabagh, T.O. Ruptured uterus still an obstetrical problem. Saudi Med. J., 1987;8:495-98.
2. Dearley, J.M. Maternal injuries and complications. Dewhursts text book of obstetric and gynaecology for postgraduate. Blackwell Scientific Publication, 1986;p.422.
3. Golan, A., Sandbunk, O. and Rubin, A. Rupture of pregnant uterus. Obstet. Gynaecol., 1980;50:549-54.
4. Rendle-Short, C.W. Rupture of gravid uterus in Uganda. Am.J.Obstet. Gynecol., 1960;79:1114-20.
5. Symone, M.E. Essential obstetrics and gynaecology, London, Churchill Livingstone, 1987,p.3.
6. Fatima, B. Review of uterine rupture in Sir Ganga Ram Hospital, Proceedings of first Pakistan Congress of Obstetric and gynae. November 1978, Lahore, pp 28-32.