Determinants of rupture of the unscarred uterus and the related feto-maternal outcome: current scenario in a low-income country

Background Rupture of the gravid uterus is one of the most grievous obstetric events accounting for considerable maternal morbidity and mortality. Materials and Methods An audit over a period of 2 years from October 2010 to September 2012 was performed on pregnant women irrespective of gestational age who had a uterine rupture of a uterus, presumed to be unscarred. Results There were 141 ruptures among 43,886 deliveries (0.3%). Of those, 18 (12.8% of the ruptures and 0.04% of the deliveries) occurred in presumed unscarred uteri. The aetiologies were: obstruction 50%, uterine anomaly 22.2%, oxytocic administration 16.6 %, instrumental deliveries 5.5% and miscellaneous 11.1 %. Hysterectomy was performed in 55.6% of cases. Fetal mortality was 83.3% and maternal mortality was 16.6%. Conclusions Training of traditional birth attendants for early referrals, screening for uterine anomalies by ultrasound in early pregnancy and counselling the women, especially multiparas and grand-multiparas are mandatory. Oxytocin should only be used for those if the doctor who prescribed its use stays with the patient continuously and stops oxytocics as soon as there are reasonable contractions. In emergency, the decision to delivery time should be less than 30 min. These are some ways through which a tragic event like uterine rupture and its consequences can be averted.