Analysis of uterine rupture in a tertiary center in Eastern Nepal: lessons for obstetric care.

AIM: To determine the etiologic factors, clinical presentation, management and fetomaternal outcome in cases of rupture of the gravid uterus and propose preventive measures.
METHODS: A retrospective analysis of cases of uterine rupture was carried out at B.P. Koirala Institute of Health Sciences, Nepal, between February 1999 and January 2004.
RESULTS: There were 126 cases of uterine rupture with incidence of one in 112 deliveries. Twenty-five patients (19.8%) had a cesarean scar. Obstructed labor was the common antecedent factor in the unscarred group (46.5%) and use of oxytocics accounted for maximum ruptures (44%) in the scarred category. Patients with an unscarred uterus presented with hypotension and intrauterine death (89.1%), while abdominal tenderness (76%) and fetal distress (64%) were common modes of presentation in the scarred category. Complete rupture was seen in 84.9% of patients. Lateral wall ruptures (71.3%) necessitating hysterectomy (75.2%) were seen in the unscarred group. Anterior ruptures (92%) and repair (84%) were common in the scarred category. Maternal mortality was 13.5% and perinatal mortality 83.3%; these were both higher in the unscarred uterus.
CONCLUSION: The incidence of uterine rupture is high in Eastern Nepal and rupture of the unscarred uterus carries graver risks. Regular antenatal care, hospital deliveries and vigilance during labor with quick referral to a well-equipped center will reduce the incidence of this condition.