common risk factor, Other risk factors are full-thickness incisions, dysfunctional labor, labor

augmentation by oxytocin or prostaglandins, and high parity and trauma. In this

socioeconomic environment, the management of all obstetric emergencies is likely to be
extremely difficult.

MATERIALS AND METHODS

This study examined all cases of ruptured uterus managed in the Department of Obstetrics
and Gynaecology at Mamata General hospital, Khammam over a 3 year period.

Details were obtained from medical records retrospectively and analyzed manually.

RESULTS
Complete uterine rupture occurred in 13 cases, with an incidence of 1:248. The ages of the
women ranged from 18 to 32 years. All were multigravida. Seven were term, 3 preterm, and 3
were second trimester ruptures in uteri with congenital anomalies. All 13 cases had varied
etiologies and presentations such as poor antenatal care, previous cesarean section scar was
present in 8, uterine anomalies were noted in 3, history of trauma was present in 1 case, and 1
case was grand multipara who set into spontaneous labour. Sonography findings in all cases
showed an empty uterus surrounded by echogenic intraabdominal fluid (hemoperitoneum)
with dead fetus and placenta in maternal abdomen. Most patients were in shock and required
basic life support, intravenous fluids, blood transfusion, and emergency laparotomy. Few
required intensive care and ventilator support. Operative management included uterine rent
repair with bilateral tubal ligation in 8 cases [Figures 1-3], excision of ruptured uterine horn
with unilateral tubal ligation in 3 cases [Figures 4 and 5], and subtotal hysterectomy in 2
cases [Figures 6 and 7]. There were no maternal deaths and 100% perinatal deaths were seen
[Tables 1, 2].

DISCUSSION
Among the women in this series, the lack of any antenatal care is strikingly frequent – 100%.
However, this lack of antenatal care probably reflects the lack of access to obstetric care in
general. It is the lack of access to emergency obstetric care, in particular emergency cesarean
section and blood transfusion, that is the problem in many developing countries.[2,3]