Rupture of gravid uterus: a eight-year clinical analysis and review of the literature.

Nine cases of ruptured gravid uterus occurred at the Chang Gung Memorial Hospital from July 1983 to June 1991. The incidence is 1/3871. Six (66.7%) of the nine cases of uterine rupture involved rupture of intact uteri. The remaining three (33.3%) occurred in uteri scarred by a previous cesarean-section. The common contributing factor to rupture of an intact uterus was injudicious use of a uterine stimulant; whereas the common etiology of rupture of a scarred uterus was a previous scar rupture or dehiscence. In this series, there was no maternal mortality; however, three (33.3%) of the infants died. The fetal death rate was higher with rupture of an intact uterus, 50.0%, as opposed to 0% with rupture of a scarred uterus. Abnormal labor course and clinical features (palpable fetal part or regression of head, profound shock and cessation of uterine contraction) were the important tools for early diagnosis of uterine rupture. Mortality rates for the mother and fetus can be decreased with a high index of suspicion, early diagnosis, and immediate surgical intervention.