Case series: Uterine rupture, a district general hospital experience in the UK
BJOG: An International Journal of Obstetrics and Gynaecology, April 2014, vol./is. 121/(141-142), 1470-0328 (April 2014)
Author(s): Nausheen S.; Clare A.
Abstract: Background Uterine rupture is a rare obstetric emergency associated with significant adverse fetal and maternal outcomes. In high-income countries, the incidence is very low in women with an unscarred uterus at <2 in 10 000. However, the risk is increased in women who have had a previous caesarean section. They must be counselled during pregnancy about their options for mode of delivery, either elective repeat caesarean section or vaginal birth (VBAC). The RCOG advises that women should be informed of the risk of uterine rupture as 22-74/10 000 deliveries, and the ACOG quote a rate of 0.5-0.9%. This risk is increased by induction of labour or other uterine scars, such as inverted T or classical segment scars. Cases This series presents seven patients with uterine rupture seen at a UK district general hospital over a 3-year period between 2010-2013. During this period, we had 6049 deliveries, 732 of whom will have had a previous caesarean section. Less than half of these women opted for elective repeat caesarean section and so 417 women chose a VBAC. This gives a local rate of term scar rupture of 1.1% in women. In these patients the rupture was not always associated with excessive pain or CTG abnormalities. The diagnoses were made prior to the onset of labour as well as in labour and postnatally. One woman who did not realise she was pregnant and presented to accident and emergency in a state of shock. An ultrasound revealed a fetus in abdomen. During labour, rupture occurred with and without syntocinon augmentation and one case presented postnatally when she had a retained placenta.
Full Text: Available from Wiley in BJOG: An International Journal of Obstetrics and Gynaecology
In theatre, the placenta was no longer in the uterus and found in left hypochondrium. All of these patients had a previous caesarean section, most were overweight or obese and none required a hysterectomy. Five of the cases had good fetal outcomes but there was one stillbirth and one baby with HIE. Conclusion Our case series demonstrates the range of presentations and outcomes that can be seen with the ruptured uterus. It has highlighted the increased risk associated with obesity, syntocinon and the need to be vigilant in all patients with a uterine scar. A regular medical review of women having a VBAC will ensure urgent action if concerns occur. The thorough antenatal counselling of women is of paramount importance, which should be personalised and include local accurate data.
Publication Type: Journal: Conference Abstract