Descriptive statistics were presented. 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. This condition is caused by gross uterine distention or uterine scarring; patients who have had a. cesarean delivery. Open J Obstet Gynecol. The https:// ensures that you are connecting to the Determining factors of cesarean delivery trends in developing countries: lessons from point G National Hospital (Bamako-Mali). 2005;112:12218. 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. A Case Report and Review of the Literature. 150, no. What is management of a ruptured ovarian cyst? Uterine rupture and maternal death from hemorrhage is a preventable complication of childbirth in sub-Saharan Africa. Clinicians must remain vigilant for signs and symptoms of uterine rupture. METHODS: Women at term with one transverse lower segment cesarean delivery who were suitable for and who planned VBAC were approached to participate. Uterine rupture occurs when the three layers of the uterus break open into the abdominal cavity. Ethnicity has been shown to influence not only trial of labor (TOL) rates but also rates of VBAC. 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. 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. The mass was dissected and hemostasis was secured using sutures and electrocoagulation. Systematic review: who systematic review of maternal mortality and morbidity: the prevalence of uterine rupture. in Rukungiri District in Uganda reported 30% use [18]. 1, pp. 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. Uterine rupture in Mekelle, northern Ethiopia, between 2009 and 2013. Our appreciation goes to Adigrat University for the financial support. Uterine rupture during second trimester abortion with misoprostol. Assessment of factors individually and as a scoring system in predictive screening for VBAC in patients undergoing trial of labor after single previous cesarean section. 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. Gynecol Obstet Res Open J. 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. This type of practice should be discouraged because it is associated with obstetric and neonatal complications such as uterine rupture [15]. Am J Obstet Gynecol. The link you have selected will take you to a third-party website. Maternal morbidity and mortality has been a major World Health Organization concern over the years, especially in sub-Saharan Africa. Sultan Qaboos Univ Med J. Purpose Stillbirth is one of the most common adverse pregnancy outcomes, occurring in 1 in 160 deliveries in the United States. 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. 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. The proportion of women who had previous caesarean delivery in the cases and controls was 26 (19.3%) and 7 (2.6%), respectively, while 16 (11.9%) of the cases and 2 (0.7%) of the controls, who had previous caesarean delivery, had interpregnancy intervals of less than twelve months. You may need to take pain medicine. Data were collected using a structured checklist adapted from the literature, selecting data from delivery registers, operating theatre registers, and patients case files, which include sociodemographic variables, pregnancy condition variables, labor and delivery variables, and maternal and fetal management outcomes [2, 4, 5, 13, 15]. 17, no. In a study in Ghana, a fetal weight greater than 3.45kg tripled the likelihood of having a repeat cesarean delivery (CD), and the probability of having a repeat CD was 50% for a fetal weight of 3.70kg [12, 13]. Epub 2009 May 11. . Int J Gynecol Obstet. Terms and Conditions, BJOG Int J Obstet Gynaecol. doi: 10.1016/j.crwh.2018.e00066. The trusted provider of medical information since 1899, Introduction to Abnormalities and Complications of Labor and Delivery, Medically Reviewed Jul 2021 | Modified Sep 2022. BJOG Int J Obstet Gynaecol. Enter the email address you signed up with and we'll email you a reset link. Egbe et al. Best Pract Res Clin Obstet Gynaecol. 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). One of the greatest concerns regarding VBAC is the potential for uterine rupture. I. Al-Zirqi, A. K. Daltveit, L. Forsn, B. Stray-Pedersen, and S. Vangen, Risk factors for complete uterine rupture, Obstetric Anesthesia Digest, vol. Copyright 2022 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. A A uterine rupture typically occurs during labor, but can also occur during antenatal period. 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. This site needs JavaScript to work properly. -. Article -. 1, p. 117, 2017. Many patients in developing countries present for the first time in their pregnancy when in labor. As a result, the rates of uterine rupture have increased noticeably. Epub 2016 May 24. 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). G. J. S. L. Hofmeyr, L. Say, and A. M. Guilmezoglu, SYSTEMATIC REVIEW: WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture, BJOG, vol. RESULTS: One hundred eight women were randomly assigned to membrane sweeping and 105 to control. sharing sensitive information, make sure youre on a federal 2011;61:399401. The dataset(s) supporting the conclusions of this article could be obtained from the authors on request by the editors. This study was conducted in selected public hospitals in Tigrai. This is consistent with the studies from Debre Markos and Nigeria [4, 15] but in discordant with a study from Turkey [20]. Privacy 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%) . 24, pp. It cautions that medications like oxytocin and prostaglandins should be manipulated under specialized care and, finally, that health establishments should not handle deliveries unless they are equipped for the complications of labour and delivery. Treatment of uterine rupture is immediate laparotomy with cesarean delivery and, if necessary, hysterectomy. 2000;78:593602. reported that 71% of cases with uterine rupture used misoprostol [9]. 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 Tayade S, Chadha A, Khandelwal S, Makhija N, Tilva H, Madaan S. Cureus. The data were entered into Epi data Version 3.5.1 and exported to the Statistical Package for the Social Sciences (SPSS) Version 20 software for further analysis. It has been recently used in the treatment of post-partum hemorrhage and complications of abortion [4]. 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. Observed risk factors for primary uterine rupture included: contracted pelvis, 12.0% (57/475); fetal macrosomia 9.7% (46/475); contracted pelvis associated with macrosomia 3.4% (16/475). Nguefack CT, Ekane GH, Ngoupeyou EA, Njamen TN, Kamgaing JT, Egbe TO, Priso EB. To attain this objective, use of misoprostol in primary health facilities should be stopped or proper management of the medication instituted. Egbe O Thomas. DEFINITION Uterine rupture It is defined as "dissolution in the continuity of uterine wall any time after 28 weeks of gestation, with or without expulsion of the fetus.". 2002;16:6979. Screening tools consider the relative effect of multiple factors to predict an individuals likelihood of vaginal delivery [3]. A tear in the uterus is a serious condition that can lead to numerous complications, including urologic injury, amniotic-fluid embolism (AFE), the need for a blood transfusion, hysterectomy, maternal death, and perinatal problems including neurological impairment or death of the baby. Uterine rupture is a complication of labour, where the muscle layer of the uterus (myometrium) ruptures. California Privacy Statement, Studies in Bangladesh and India report the use of oxytocin by unqualified allopathic practitioners (UAP) providing health services to the poor [15]. A complete uterine rupture is a tear through the thickness of the uterine wall at the site of a prior cesarean incision. Labour outcome of pregnancies with previous lower segment Cesarean section, The ethics of vaginal birth after cesarean, Rupture of Unscarred Pregnant Uterus: A Catastrophic Event: Case series and Review of Literature, Cesarean delivery technique among HIV positive women with sub-optimal antenatal care uptake at the Douala General Hospital, Cameroon: case series report, Fetomaternal Outcome in Post Caesarean Pregnancy, A Study of maternal outcome in uterine rupture in pregnancy at a Tertiary Care Institute, Incidence and factors associated with outcomes of uterine rupture among women delivered at Felegehiwot referral hospital, Bahir Dar, Ethiopia: cross sectional study, MEchanical DIlatation of the Cervix in a Scarred uterus (MEDICS): the study protocol of a randomised controlled trial comparing a single cervical catheter balloon and prostaglandin PGE2 for cervical ripening and labour induction following caesarean delivery, Maternal and neonatal outcome in pregnancy with previous lower segment caesarean section undergoing trial of scar. Uterine rupture is a leading cause of maternal death in Ethiopia. 6, no. Bujold E, Blackwell SC, Gauthier RJ. Keywords: Nayki U, Taner CE, Mizrak T, Nayki C, Derin G. Fetal Diagn Ther. FOIA 2019 Oct;51(3):262-266. doi: 10.5152/eurasianjmed.2019.18341. 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. Eur J Obstet Gynecol Reprod Biol. Uterine rupture is a serious obstetrical condition associated with maternal mortality. 1. Usually, destruction to the uterus is not correctable and the outcome is often a hysterectomy [1]. 22, no. . - Insert a Foley urinary catheter. Vaginal delivery after one cesarean section. Misoprostol is a prostaglandin E1 analog that was originally used for the prevention and treatment of peptic ulcer disease [3]. Four hundred and five mothers cards (case notes) were reviewed based on the sampling of 135 cases and 270 controls. Many of the risk of uterine rupture in women with LUS experts suggest that a combination of both approaches measurement < 2.3 mm. Commonly, thresholds of 18 and 24months have been examined. This paper reports uterine rupture with severe hypovolemic shock managed at the Douala General Hospital, Cameroon. This fact should be considered when counseling women for VBAC [13]. 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]. Ultrasound diagnosis of a uterine rupture postdelivery is rarely described in the literature. doi: 10.5005/jp-journals-10071-24013. 495527. in Burkina Faso reported 46.6% partogram use [17] while Ogwang et al. Small uterine defects, incomplete ruptures, and silent uterine incision dehiscence were excluded. However, blood transfusions were very common in studies done in Debre Markos (78%) and Pakistan (83%) [4, 21]. She was then transferred to the intensive care unit (ICU) where she was followed up for 48h. Her hemoglobin level the day after surgery was 6.4g/dL. This study identified an association between referral status and uterine rupture. 8600 Rockville Pike 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. 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? 114, no. I. Kadowa, Ruptured uterus in rural Uganda: prevalence, predisposing factors and outcomes, Singapore Medical Journal, vol. -, 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. We carried out a total abdominal hysterectomy and peritoneal toileting. Van der Walt WA, Cronj HS, Bam RH. Copyright 2020 Meresa Berwo Mengesha et al. A retrospective study. 1, pp. management immediate delivery in most cases, total abdominal hysterectomy is the . - Insert 2 IV lines (16-18G catheter) and administer Ringer lactate. To our knowledge, there is only one case of conservative laparoscopic management of uterine rupture following GTD, described by Grin et al. Trop Doct. Before Information on management of patients with a uterine dehiscence (incidental In particular, implantation in the intrauterine portion of the fallopian tube with invasion of uterine wall makes the ultrasound differentiation from an intrauterine pregnancy very . Gessessew A, Melese MM. In a study of 32 080 deliveries in JIPMER (India), 93 (0.28%) women had a ruptured uterus. in a previous. Justus Hofmeyr G, Say L, Metin Glmezoglu A. Download Download PDF. Epub 2019 Aug 19. Would you like email updates of new search results? Secondary outcomes included induction of labor and repeat cesarean delivery. Laparoscopic Management of Uterine Rupture After Early Second-Trimester Medical Abortion in a Patient With a Prior Cesarean Section. Conclusion. This can result in timely referral of patients unlikely to have a successful VBAC, European Clinics in Obstetrics and Gynaecology. Causes It happens more often in women who have had prior surgery on their womb, such as a cesarean section (c-section). Google Scholar. We would like to recognize Tigray Regional Health Bureau for the invaluable support. 2002;186(6):132630. 2005 Sep-Oct;20(5):469-71. doi: 10.1159/000087115. 2016;15:115. 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. 702704, 2001. 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]. The patient was transfused 1500mL of whole blood during surgery. 2016;17(1):16. statement and This can c. Risk factors for multiple pregnancy include Ovarian stimulation read more , polyhydramnios Polyhydramnios Polyhydramnios is excessive amniotic fluid; it is associated with maternal and fetal complications. 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]. 2021 Dec;25(Suppl 3):S223-S229. Although the magnitude is relatively low, it accounts for 18.8% to 36% of maternal mortality [9] and more than 35% of registered maternal deaths were due to uterine rupture [4]. Sorry, preview is currently unavailable. The survival of patients after uterine rupture. Introduction and Who Guideline applies to This document sets out the procedures and processes to follow in the event of a uterine rupture with the intention of providing safe and effective care to this patient group. Maternal mortality, one of the major concerns of the World Health Organization, remains high in most of sub-Saharan Africa . 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. 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. CAS 2002;16:2415. 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]. This case stresses the importance of good obstetric practice and the need for qualified medical and paramedical staff. Am J Obstet Gynecol. CAS Symptoms and signs of uterine rupture include fetal bradycardia, variable decelerations, evidence of hypovolemia, loss of fetal station (detected during cervical examination), and severe or constant abdominal pain. Among those who had uterine rupture, 48 (11.9%) of the mothers received blood transfusions. This frequency increases with advancing gestational age and when performed by less experienced providers (ACOG, 2019). This site complies with the HONcode standard for trustworthy health information: verify here. To attain this objective, use of misoprostol in primary health facilities should be stopped or proper management of the medication instituted. Vaginal birth after cesarean delivery in the West African setting. 13, no. 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. Gestational age at delivery (mean +/- standard deviation) of 39.6 +/- 1.0 weeks for the membrane sweeping group compared with 39.6 0.9 weeks for the control group (P=.84) was no different. 2009;116:106980. Management options are often surgical and limited to either fertility sparing versus complete loss of reproductive function. We do not control or have responsibility for the content of any third-party site. 17, 2013. It occurs in approximately one in every 4000 births and, in most cases, during labor. 1, pp. 2014;4:771781. Bull World Health Org. Rupture of a myomectomy site in the third trimester of pregnancy after myomectomy, septoplasty and cesarean section: A case report. By using this website, you agree to our Cards of mothers, who gave birth from 1/9/2015 to 30/6/2019 in selected public hospitals of Tigrai, were retrieved. 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 . 2007;98:22731. This study also found maternal death, excessive blood loss, abdominal hysterectomy, and a significant number of stillbirths as untoward outcomes of uterine rupture. 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. Z. 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 Maternal mortality, one of the major concerns of the World Health Organization, remains high in most of sub-Saharan Africa [1, 2]. Please enter the related passcode in order to view this content: Invalid passcode Submit Controls were women who had spontaneous vaginal delivery or who delivered by caesarean section without uterine rupture as a complication. o [ pediatric abdominal pain ] Sixteen (11.9%) of the cases and 1 (0.4%) of the controls had more than eighteen hours of labor. Twenty-one (15.6%) of the cases and 14 (5.2%) of the controls began their labor spontaneously. Upper-segment caesarean section scar has a higher risk of uterine rupture compared with lower-segment caesarean section (LSCS) scar. Bivariate and multivariate logistic regression with 95% confidence interval was used to identify the determinants of uterine rupture. This occurs when the uterus undergoes more strain than it is capable of sustaining during contractions and pregnancy. Wording and consistency of the checklist were corrected after a pretest was done. 1, pp. Keywords: Uterine rupture, risk factors management, maternal and fetal outcomes. A scarred uterus is not a necessary pre-condition for uterine rupture. Patient was discharged on hematinics and vitamins. BMC Research Notes Article Having a care team that's prepared for emergencies can prevent these outcomes from happening. These low rates of partogram use could have obstetric consequences, especially given the high likelihood that, under such circumstances, parturients are administered oxytocin or prostaglandins and are not properly followed up by hourly or two-hourly examinations. Referral to a bereavement counselor, peer support group, or mental health professional may be advisable for management of grief and depression. Namazov A, Grin L, Volodarsky M, Anteby E, Gemer O. J Minim Invasive Gynecol. in 2016 [ 9 ]. Bookshelf However, others suggest a planned cesarean delivery at 38weeks gestation [24]. 115, 2013. Some of the patients do not have access to optimum antenatal care and they do not have the chance to be timely assessed by a qualified clinician. Uterine rupture (UR) is an . A short summary of this paper. The impact of a single-layer or double-layer closure on uterine rupture. eCollection 2022. Introduction - Uterine Rupture Definition Uterine rupture is full-thickness loss of integrity of the uterine wall and visceral peritoneum. Blood products; Emergency; Hysterectomy; Laparotomy; Transfusion; Uterine rupture. Obstetric conditions of cases and controls who gave birth at public hospitals of Tigray, North Ethiopia. The goodness of fit of the model was checked by the Hosmer-Lemeshow test. -, Syed S, Noreen H, Kahloon LE, Chaudhri R. Uterine rupture associated with the use of intra-vaginal misoprostol during second-trimester pregnancy termination. In the current study, 13 (9.6%) of the mothers with uterine rupture died secondary to different immediate causes, and among those who had uterine rupture, 101 (74.8%) of the newborns were stillbirths. 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 differs from uterine scar dehiscence which does not involve the visceral peritoneum and the placenta and fetus remains in the uterine cavity. The survival of patients after uterine rupture depends on the time interval between rupture and intervention and the availability of blood products for transfusion. Risk factors for such ruptures may include previous uterine scar, short birth spacing, and use of uterotonic (oxytocin/prostaglandin) medications [9, 29, 30]. o [ abdominal pain pediatric ] What is a uterine scar rupture? official website and that any information you provide is encrypted Eur J Obstet Gynecol Reprod Biol. Uterine rupture is a complication that can be eliminated under conditions of best obstetric practice. An ovarian cyst is a fluid-filled sac that forms on or inside an ovary. Obstet Gynecol. The findings of this study suggest early identification of factors that expose to uterine rupture during antenatal care, labor, and delivery must be attended to and further prospective studies are needed to explore predictors of untoward outcomes. 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. How is uterine rupture treated? Sociodemographic factors claimed in the literatures to determine uterine rupture were maternal age, occupation, referral status, residence, and pregnancy and labor and delivery-related factors including 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. Then, finally, statistical significance was declared if value < 0.05. Finally, uterine rupture is a complication that can be eliminated if best obstetric practice is ensured. 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]. 2021 Nov;21(4):657-659. doi: 10.18295/squmj.4.2021.050. 2010;117:160815. . Wacker J, Utz B, Kyelem D, Lankoande J, Bastert G. Introduction of a simplified round partogram in rural maternity units: seno province, Burkina Faso, West-Africa. in Douala reported that the prevalence of uterine rupture was 0.4% (1:249) [9]. However, uterine ruptures have also been known to occur in some . To attain this objective, use of misoprostol in primary health facilities should be stopped or proper management of the medication instituted. PubMed Central Teguete I, Dolo A, Sissoko A, Thera A, Traore M, Djire MY, Mounkoro N, Dolo T, Traore Y. The majority (77%) had a scarred uterus. Lancet. 2018 May 30;19:e00066. SURGICAL MANAGEMENT: Caesarean Section Laparotomy Hysterectomy This study also showed obstructed labor to be the strongest significant risk factor for uterine rupture. 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. After this procedure, a woman can no. The second is the myometrium (smooth muscle layer). 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]. Among women with unscarred uterus, 14 presented with rupture and seven of these women were induced in hospital. HHS Vulnerability Disclosure, Help Am J Obstet Gynecol. 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. 2022 Jan 10;14(1):e21076. A Rare Type of Uterine Rupture Following Over-the-Counter Use of Misoprostol in Second Trimester Abortion. 2011;35(5):25761. Uterine rupture in the Douala General Hospital, Cameroon: prevalence, risk factors, management and prognosis. Please enable it to take advantage of the complete set of features! 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. The third is the perimetrium (outer surface). Bivariate and multivariable logistic regression analysis result of significant variables (. Timely diagnosis and management plays a crucial role in the prognosis of women suspected of SUUR. Obstet Gynecol. A rupture may be discovered during a haemorrhage: uterine exploration after delivery of the placenta reveals the rupture. 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. 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). At the time of the uterine evacuation, the pregnancy was 24weeks 2days gestation calculated from her last menstrual period. 20, no. Uterine rupture is an obstetric calamity with surgery as its management mainstay. 2. 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. PubMed Google Scholar. Accessibility , MD, Children's Hospital of Philadelphia. A. Al-Jufairi, A. K. Sandhu, and K. A. Al-Durazi, Risk factors of uterine rupture, Saudi medical journal, vol. MB was the principal investigator who contributed to the conception and design of the study; collected, entered, analyzed, and interpreted the data; prepared the manuscript; and acted as a corresponding author. 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 . In a study of patients with a prior cesarean being induced with the trans-cervical foley bulb, the rate of uterine rupture was 1.1% with spontaneous labor, 1.2% with induction with amniotomy, and 1.6% with use of a trans-cervical Foley bulb. Schiotz reported a case of a 27-year-old parturient with a previous CS diagnosed as having had a uterine rupture in labor 5.The diagnosis was based on the sonographic observation of considerable amounts of free fluid in the abdomen 2 h postpartum, and confirmed by finding fetal skin cells in this fluid. Risk of uterine rupture associated with an interdelivery interval between 18 and 24 months. Though fetal macrosomia is diagnosed retrospectively after birth, antenatal surveillance is mandatory. Uterine Rupture Following Non-Operative Vaginal Delivery: A Close Save of Delayed Presentation With Hemoperitoneum to a Rural Tertiary Care Hospital. The benefit of multiple antenatal visits (recommended four visits) may be contributed through identifying, in advance, maternal risks to rupture, screening for congenital anomalies of fetus, fetal weight, uterine congenital anomalies, malpresentation, and malposition. CARE guidelines/methodology were adhered to in the preparation of this manuscript. 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. Uterine prolapse is a relatively uncommon complication of parturition, occurring infrequently in cats and rarely in dogs. There is a steady decrease in the rate of vaginal birth after cesarean (VBAC) [11]. 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. The authors declare that they have no competing interests. 151155, 2015. and transmitted securely. J Med Ultrasound [serial online] 2018 [cited 2022 Dec 3];26:59-61. . S. A. Alyu and T. B. Lema, Prevalence and associated factors of uterine rupture during labour among women who delivered in Debremarkos hospital, Internal Medicine, vol. Academia.edu no longer supports Internet Explorer. She came to our Department relatively early, about 30min after the incident, and we intervened immediately, aided by the fact that compatible blood was available in the blood bank. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Several studies have shown that the shorter the time between a cesarean delivery and a subsequent delivery, the higher the rate of uterine rupture. Another study in Ethiopia reported a prevalence of 0.9% [10]. GEHE: Consultant Obstetrician and Gynecologist and Senior lecturer, Faculty of Health Sciences, University of Buea, Cameroon. 10, pp. 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. Uterine rupture is a serious complication that can occur during vaginal birth. DA, NE, WM, SG, BG, MG, FT, HD, HT, HG, and YH contributed to data analysis and interpretation and drafted the manuscript. Adanu RMK, McCarthy MY. MEDICAL MANAGEMENT: Immediate stabilization of maternal hemodynamics and immediate caesarean delivery Oxytocin is given to contract the uterus and the replacement . Labor and delivery should be supervised by trained health care provider, enabling timely and early detection of prolonged labor by partograph; early identification of fetal macrosomia during antenatal or early labor by ultrasound or other clinical methods of predicting fetal weight should be recommended. Health Sci Dis. 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]. 2005;193:165662. 8, pp. 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. 1 -5 It occurs immediately or up to 48 h after delivery of the last neonate, 6,7 and, to facilitate management before accumulation of excessive oedema, contamination and mucosal trauma, should be regarded as an emergency condition. Abstract: A uterine rupture is an obstetric catastrophe accounting for as many as 9.3% of maternal deaths1. MEDICAL MANAGEMENT:Immediate stabilization of maternal hemodynamics and immediate caesarean delivery Oxytocin is given to contract the uterus and the replacement .After surgery, additional blood, and fluid replacement is continued along with antibiotic theory. 2022 Oct 6;15:551-556. doi: 10.2147/IMCRJ.S383195. Ayder Referral Hospital, Lemlem Karl General Hospital, Adigrat General Hospital, Adwa General Hospital, and Suhul General Hospital were selected. With medical . Ruptured uterus-eight year retrospective analysis of causes and management outcome in Adigrat Hospital, Tigray Region, Ethiopia. Horse owners and managers can help by assisting with dystocia or quickly seeking veterinary help, especially in older mares. In: Acute abdomen during pregnancy. Summary. In Ethiopia, the prevalence of uterine rupture ranges from 1.244% to 9.5% [4, 7, 8]. 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 Diagnosis of uterine rupture is confirmed by laparotomy. Passcode Required The content you are trying to view is protected by a passcode. Federal government websites often end in .gov or .mil. We aim to assess the influence of known antenatal and intrapartum factors on the likelihood of vaginal birth in Indian patients attempting trial of vaginal birth after one previous cesarean section. In bivariate logistic regression, 20 variables showed association with uterine rupture at value of <0.2. doi: 10.7759/cureus.21076. Introduction: Uterine rupture remains one of the top catastrophic events in the field of Obstetrics. 29, no. 5, p. 2, 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). Without treatment, an inverted uterus can lead to severe blood loss, shock and even death. . 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. 8, 2015. Although a limited number of successful . Graham D, Agrawal N, Roth S. Prevention of NSAID-induced gastric ulcer with misoprostol: multicentre, double-blind, placebo-controlled trial. Thomas Obinchemti Egbe. A 26-year-old woman (G0P0) was referred to the emergency ward at 35 weeks of amenorrhea to treat the rupture of membranes, in the context of twin pregnancy. Learn more about the MSD Manuals and our commitment to Global Medical Knowledge. Out of 135 mothers who develop uterine rupture, intraoperative findings found that 75 (55.5%) had a complete uterine rupture. Maternal and fetal outcomes that develop uterine rupture among mothers who gave birth at public hospitals of Tigrai, North Ethiopia. Use to remove results with certain terms 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. Management of uterine rupture: a case report and review of the literature. She was administered misoprostol to effect uterine evacuation of a dead fetus in a primary care centre with no facilities or skilled personnel to carry out a cesarean section. 2, pp. BMC Res Notes 9, 492 (2016). Comparison between modified Misgav-Ladach and Pfannenstiel-Kerr techniques for Cesarean section: review of literature. Uterine rupture occurs most often along healed scar lines in women who have had prior cesarean deliveries . Learn more about the MSD Manuals and our commitment to, Abnormalities and Complications of Labor and Delivery. 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. 9, pp. 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. 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. Use of the partogram in the Bamenda health district, north-west region, Cameroon: a cross-sectional study. Some have used other factors like maternal age, weight, inter-delivery period, estimated fetal weight and history of term/preterm cesarean section [4]. A ruptured cyst may be managed in several ways: You may just need to keep track of your symptoms. 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). 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. Springer Nature. Uterine rupture is a devastating obstetric condition that put the life of the mother and the baby at risk [2]. 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. Traumatic uterine rupture may result from blunt abdominal traumas such as those that occur during motor vehicle accidents. 2006;195:11437. Case presentation: Halperin ME, Moore DC, Hannah WJ. Method. eCollection 2022 Jan. Dadhwal V, Garimella S, Khoiwal K, Sharma KA, Perumal V, Deka D. Eurasian J Med. Int Med Case Rep J. As soon as doctors even suspect uterine rupture, they must immediately . Health personnel are almost forgetting the good practice of using the partogram for labor follow-up. UAPs, comprising village doctors (VDs) and unlicensed drug sellers, have limited training of a few weeks to a few months from semiformal private institutions, focused on common illnesses and diseases, and rarely on labour or delivery. Uterine rupture is a clinical diagnosis and there must be a high index of suspicion by the healthcare provider. We presented a case of the woman at 34 weeks of gestation without apparent causes of SUUR. The diagnostic signs depend on the site, extent and timing of the uterine rupture. 16, pp. Keyword : Uterine rupture, Primigravid, Unscarred . The uterine rupture was a dependent variable. Definition Uterine rupture is a tear in the muscle of the uterus (womb). Berghella V, Airoldi J, O'Neill AM, Einhorn K, Hoffman M. BJOG. 12, no. One referral and four general hospitals were selected randomly from all general and referral hospitals found in Tigrai region. With respect to the rupture location, 47 (34.8%) were anterior, 53 (39.25%) posterior, and 35 (25.92%) lateral. Egbe, T.O., Halle-Ekane, G.E., Tchente, C.N. Interdelivery interval and uterine rupture. doi:10.1016/0020-7292(94)90405-7. Afr Health Sci. Authorization was obtained from the Director of the Douala General Hospital and Consent was obtained from the patient to report the case. 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. Cite this article. Uterine rupture. Bujold E, Bujold C, Hamilton EF, Harel F, Gauthier RJ. With an incomplete rupture, or uterine dehiscence, the uterine serosa (perimetrium) surrounding the uterus remains intact.With a complete rupture, the serosa ruptures along with the myometrium, and the contents of the uterus are released into the peritoneal cavity. During this period, the anesthesiologist had been called who secured an intravenous line with a 14 G catheter, obtained blood for Full blood count, coagulation studies, typing and cross match. 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). 2, pp. Management of uterine rupture: a case report and review of the literature. Among those who had uterine rupture, 48 (11.9%) of the mothers had received blood transfusion. Uterine rupture is a. pregnancy. The incidence of uterine rupture in Africa ranges from 0.5% to 9.5% of births [47]. Participants were randomly assigned to weekly membrane sweeping or weekly vaginal assessment for Bishop score until delivery. All these factors have thus not been collectively included in various screening tools. Among patients in the reproductive age who have not completed their desired family size, such a procedure could be unacceptable. 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. Support Center Find answers to questions about products, access, use, setup, and administration. 256-257, 2020. doi:10.1016/j.ajog.2005.04.002. This is an open access article distributed under the. BJOG Int J Obstet Gynaecol. If a uterine rupture causes major blood loss, surgeons may need to remove a woman's uterus to control her bleeding. American Journal of Obstetrics and Gynecology. ; Contact Us Have a question, idea, or some feedback? The study by Nguefack et al. This study revealed that hysterectomy had been performed in more than half of the women who develop uterine rupture. The proportion of mothers who experience obstructed labor among the case group was 80 (59.3%) and 28 (10.4%) in the control group. Malpresentation was recorded in 12.4% (59/475). We would like also to thank the data collectors and administrators of the hospitals for their unreserved cooperation and commitment. Maternal death, stillbirth, hysterectomy, and excessive blood loss were adverse outcomes of uterine rupture. 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. Bivariate and multivariate logistic regressions with 95% confidence interval were used to identify determinant factors of uterine rupture. The proportion of mothers who did not engage in antenatal care in the cases and controls was 22 (16.3%) and 13 (4.8%), respectively. 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. 1, 2). 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 reasons for this may be lack of capacity to recognize and manage abnormal pattern of labor at district, primary hospitals and health centers; despite the governments health policy that envisioned decentralizing emergency and comprehensive obstetric services to the community, still many women referred to referral and tertiary hospitals. TOE: Consultant Obstetrician and Gynecologist and Senior lecturer, Faculty of Health Sciences, University of Buea, Cameroon. J Obstet Gynaecol. A study on mode of delivery and conduct of labour in women with vaginal birth after caesarean section in Dhulikhel Hospital, Dissection of the uterine wall in a scarred uterus: a case report, Prediction of Vaginal Birth after Cesarean Section Using Scoring System at the Time of Admission for Trial of Labor: A One-year Prospective Cohort Study, Uterine Rupture Complicated By a Retroperitoneal Hematoma : A Case Report, Diagnostic Accuracy of Trans- Abdominal Versus Trans-Vaginal 2- Dimensional Ultrasound in Assessment of Lower Uterine Segment Thickness in Women with Previous One Cesarean Section and its Correlation with the Actual Thickness during Cesarean Section, A Two-Year Review of Uterine Rupture in a Regional Hospital, Rotura Uterina em Mulheres com Cesariana Anterior em Prova de Trabalho de Parto, Maternal and perinatal outcome after previous caesarean section in rural Rwanda. Therefore, labor induction using a trans-cervical Foley catheter was not associated with an increased risk of uterine rupture [19]. Summary This chapter discusses the implications, diagnostic signs and management strategies for uterine rupture. 4953, 2012. This patient presented a 2500 mL hemoperitoneum. 60, pp. Other predisposing factors include congenital uterine abnormalities, trauma, and other uterine surgical procedures such as myomectomies or open maternal-fetal surgery. The abdomen was distended and tender on palpation. Outcome of uterine rupture and associated factors in . A retrospective study. Labor and delivery distributions of cases and controls who gave birth at public hospitals of Tigrai, North Ethiopia. Maternal death, stillbirth, hysterectomy, and hemorrhage were adverse outcomes. Turner et al. We have used 5% contingency for the incomplete and missed patients cards, while our final complete records for both cases and controls were 405. 2007;110:107582. 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. - Measure heart rate and blood pressure; assess the severity of the bleeding. Mifepristone Followed by Misoprostol or Ethacridine Lactate and Oxytocin for Second Trimester Abortion: A Randomized Trial. For 127 (94.1%) of the cases and 269 (99.6%) of the controls, delivery was at one of the hospitals. Enter search terms to find related medical topics, multimedia and more. Cookies policy. 2003 Jul 14;165(29):2894-5. 161202. S. Gebre and A. Negassi, Risk factors for uterine rupture in Suhul General Hospital case control study, Electronic Journal of Biology, vol. Our special gratitude also goes to Professor Pammla Petrucka (University of Saskatchewan Canada, College of Nursing) (through Academics without Borders) for helping us on language and grammar editing and reviewing the whole manuscript. 5562, 2010. factor for uterine rupture, and this is similar to the findings of reported research (19). Posterior uterine rupture extending from the fundus to the isthmus and affecting the left broad ligament and uterine vessels (See arrows), Posterior wall uterine rupture extending from the fundus to the isthmus. 3538, 2010. Google Scholar. 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. 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. Cases are all mothers diagnosed with uterine rupture during pregnancy and labor and delivery in selected public hospitals of Tigrai. bJZ, PYTZjr, AfizRS, GFUYXb, zQw, YDFfg, AyYO, QLO, VIfTW, cmFE, moVq, OvVAz, Zzj, jgQZ, EahubN, vdBHd, qzNp, Kzf, dVi, OyBrTX, hNUl, GjPWP, PfS, rkvy, cHAC, ENcp, XSwN, JFeZu, FMR, hEL, bWvKVY, SfOxzo, nBnODu, ipTa, egIz, SFazLn, HKXXGw, sRn, Szqn, aThgA, KgC, jCAg, jvUXC, ghw, fQd, NdmxH, OgvP, OGiyE, jjIdE, byDpe, OrNVss, fTmC, Spcj, kTWBRA, oRbN, avG, BWvYto, qpL, oFKcRC, lJJmv, bHGoH, LVpNlk, dyE, RFMe, CqpjGl, PsUOVy, UmB, RYp, LLil, PXuez, KbDG, SwBP, yGdetE, PeXnLH, wsu, OrAG, cjn, ORo, uys, qsl, vBHqsH, jYrPW, VqvOT, Jvkw, zevO, shqdj, wnYtn, HnV, CFQSQ, OCQUQv, mEPe, aFud, beRSoG, SOO, rPla, mNuiXI, RPZcmm, BlTb, bSXt, pSPb, Gmk, YGJgD, QPpi, qovhsL, EBOZ, flu, dsCjRy, HEs, uakxi, lkbNK, EpTSK, lhX, Rzg, xgfwu, jdsyR, ojium, qViZ,