Frequency of Uterine Rupture and Its Maternal and Fetal Outcomes of Uterine Rupture among Pregnant Women

A uterine rupture is when the uterine wall is torn during labor or right after birth. It is although not common but when occurs it is catastrophic obstetrical emergency for both mother and fetus needs prompt diagnosis and expert management. Moreover it may leads women to irreversible infertility as it rottenly ends at hysterectomy. Objective: To determine the frequency of uterine rupture and its maternal and fetal outcomes among pregnant women. Methods: This Cross Sectional study was conducted at Civil Hospital Karachi in the department of Obstetrics and th th Gynecology Unit II from 8 December 2018 to 7 June 2019. A total of 317 pregnant women of gestational age >28 weeks, ful�lling the inclusion criteria were enrolled .The data were collected on prepared proforma. Results: This study includes 317 patients with age ranges from 25 to 35 years with mean age of 28.44 ± 3.62 years. In this study, frequency of uterine rupture among pregnant women was found in 7(2.2%) women and maternal mortality 1(7.69%). Conclusions: Findings of this study suggests that uterine perforation is still high and remained important factor for maternal and fetal outcome.


I N T R O D U C T I O N
A uterine rupture is when the uterine wall is torn during labor or right after birth.It is although not common but when occurs it is catastrophic obstetrical emergency for both mother and fetus needs prompt diagnosis and expert management.Moreover it may leads women to irreversible infertility as it rottenly ends at hysterectomy.Objective: To determine the frequency of uterine rupture and its maternal and fetal outcomes among pregnant women.Methods: This Cross Sectional study was conducted at Civil Hospital Karachi in the department of Obstetrics and th th Gynecology Unit II from 8 December 2018 to 7 June 2019.A total of 317 pregnant women of gestational age >28 weeks, ful lling the inclusion criteria were enrolled .The data were collected on prepared proforma.Results: This study includes 317 patients with age ranges from 25 to 35 years with mean age of 28.44 ± 3.62 years.In this study, frequency of uterine rupture among pregnant women was found in 7(2.2%) women and maternal mortality 1(7.69%).Conclusions: Findings of this study suggests that uterine perforation is still high and remained important factor for maternal and fetal outcome. .The fetus, placenta, and umbilical wire all live inside the uterine cavity in situations of uterine dehiscence (in place of uterine rupture).The pressing cesarean delivery was nished to limit the risk to the mother and fetus.We therefore performed this study to determine the incidence of uterine rupture, predisposing variables, and therapeutic modalities due to the paucity of local data.Reviewing this data may also aid in the creation of appropriate preventive strategies to lower obstetrical complications and morbidity and death rates for both the mother and the fetus.Mean gravidity was 3.32 ± 0.87.Distribution of patients according to gravida, place of living, scarred uterus and frequency of uterine rupture among pregnant women was found in in 7(2.2%) women as shown in Table 2.

Uterus
Maternal death was seen in 1(7.69%) of uterine rupture cases.Strati cation of uterine rupture with respect to different variables are given in Table 3.

D I S C U S S I O N
The uterine rupture refers back to the uterine wall being multiparty, residence (urban/ rural) and uterine rupture & its maternal and fetal outcomes.Effect modi ers age of mother, gestational age and multiparty were calculated through strati cation.Post strati cation chi square test was performed for uterine rupture and P-value ≤ 0.05% was taken as signi cant.
torn and losing its integrity because of a breach that occurs at some stage in pregnancy, childbirth, or right after transport.It's a risky obstetrics issue that regularly has negative consequences for both the mother and the fetus.Past this, it is able to display that the ladies have terrible facial outcomes along with hysterectomy-related irreversible infertility.Together, uterine rupture and labor obstruction account for 29% of all maternal deaths.This places problems associated with abortion as the number one cause of maternal mortality, accompanied by uterine rupture and obstructed labor.Even though uterine rupture is a rare prevalence in industrialized countries, it continues to be a severe public health di culty in growing nations that places the lives of many pregnant women and their fetuses in jeopardy.The prevalence of uterine rupture seems to be lower in prosperous nations than in underdeveloped countries.According to the WHO, the prevalence ranges from 2.8% to 0.6%, with a higher gure in developing countries [6].In this study, we have enrolled 317 patients, whose age range in this study was from 25 to 35 years, with a mean age of 28.44 ± 3.62 years.The majority of the patients were between 28 and 35 years of age.It was also in agreement with the study by Aziz and Yousafani, where the majority had a mean age of 30.36± 2.61 years [7]; a similar age group was noted in some previous studies [8,9].We have a majority of patients belonging to rural areas, about 61.20%, with a mean gravidity of 3.32 ± 0.87; similar gures were also quoted in some old studies [10,11].The frequency of uterine rupture in this study was 7 (2.2%) women; this was also in concordance with the ndings, which are comparable to the ndings by Nyengidiki and Allagoa, who observed uterine perforation at about 2.5% in Nigeria, while in a study in Uganda by Kadowa, observed a bit higher number of 2.9%.It may be due to a lack of health facilities and a higher gravity number [12,13].Although in developed countries this number is less, like in Ireland, it is 0.02% [14].In our study, maternal mortality was about 7.69%, similar to that recorded by Fo e and Baffoe, where maternal mortality was 8.8% [15].Some previous studies also showed similar data ranges of 6.6% and 7.8% [16,17].In our study, the commonest age for uterine rupture was 30-35 years with a mean age of 32.3±4.6 years.This was in agreement with the observations of Mbamara et al., from Nigeria, where the mean age was 30.8±-6.3 years with age ranges of 30-34 years [18].Uterine rupture has long been linked to multiparty; most cases (85.71%) of the uterine rupture in this study were in the gravida >3 group; these were also in agreement with the observation of Duhan et al., who reported that multiparty was an important risk factor in about 97.9% of cases [19].Findings of this study suggest that rupture of the uterus was more associated with the This study shows that uterine rupture is still high in countries like Pakistan and identi ed risk factors for uterine rupture can be avoided.Although multiparty and a damaged uterus are still major risk factors for uterine rupture, these risks can be mitigated by selecting patients carefully and lowering the caesarean section rate.

Table 1 :
This study enrolled 317 pregnant women with age ranges 25 to 35 years with mean age of 28.44 ± 3.62 years.Majority of the patients 236 (74.45%) were between 26 to 35 years of age with mean gestational age was 37.53 ± 2.18 weeks and the mean BMI was 29.72 ± 2.97 kg/m2 as shown in Table 1.Descriptive Statistics of Demographic Characteristics This Cross Sectional study was conducted at Obstetrics th and Gynecology Unit II Civil Hospital Karachi from 8 by using SPSS version 20.0.Descriptive statistics were calculated for study variables.Mean and standard deviation were calculated for quantitative variables like age, gestational age and BMI.Frequency and percentage were calculated for previous history of caesarean section,

Table 2 :
Descriptive statistics of variables

Table 3 :
Strati cation of uterine rupture with respect to different variables