Publication: Rupture of the pregnant uterus – A 20 year review
Date
2005
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
Nepal is a land-locked developing country located in between China and India with a population of 2.34 millions.
The male: female ratio being 49:51 and very high maternal mortality. (539/100,000 live birth – 1996) The
geography of the country makes the situation very much divergent and difficult to cater the health services,
especially operative procedures in remote places. The aims of the study are:- 1. To find out the incidence of R.U,
distance from where the patients came, age, parity antenatal attendance, type of rupture, type of intervention and
foetal outcome. 2. To suggest the concerned authorities to focus their attention to strengthen and expand
comprehensive emergency obstetric care service (CEOCS) in remote areas of the country. Material and method:
This is a retrospective study of rupture of pregnant uterus (RU) after 28 weeks of pregnancy for the period of 20
years from 1985 to 2005 A.D. (2042-2061 BS) admitted in the very busy tertiary centre for women (Maternity
Hospital, Thapathali, Kathmandu.) with approximately 16000 deliveries and 11% Caesarean section rate per year.
Available charts from hospital records of cases of R.U. admitted for the period of 20 years were analysed. During
the period, 251 cases of R.U. were admitted. Result: There were 272245 live births, 25819 Caesarean section, 270
maternal deaths and 11197 perinatal foetal deaths, during the study period. Incidence of rupture of pregnant uterus
was (0.09%) 1:1100 live-birth. There were 60% spontaneous, 29% scar rupture and 11% traumatic rupture.
Maximum cases were brought from distance of more than 70 kilometres away, between 25 – 29 years of age, (mean
age28.7), of third and fourth gravida at 36 – 40 weeks of gestational period with 68% without antenatal attendance.
Seventy percent (70%) had complete rupture. Sixty percent (60%) were managed with suture repair with bilateral
tubal ligation, 24% had only repair and 15% had hysterectomy. The case mortality of R.U. (n=20) was 7.9%. Two
percent (n=5) cases died before intervention due to arrival in moribund condition. Seventy five percent (75%) cases
had stillborn babies. Conclusion More cases of RU are coming to the hospital due to better communication and
awareness of the people outside the capital, and case- mortality is reduced compared to previous years.