| Abstract: | This paper reviews the literature since 1967 on rupture of the pregnant uterus and presents findings from a series of 47 uterine ruptures (35 of which were complete) managed by the authors. Uterine rupture accounts for 5% of maternal mortality in the US and there is some evidence that its incidence is increasing. The incidence of uterine rupture is 1:1000-1:1500 deliveries in the US but far lower if only cases of spontaneous rupture of the intact uterus are included. In the author's series, spontaneous ruptures accounted for about 25% of the total and only 17% of these occurred before the onset of labor. A uterine scar, particularly one from a previous cesarean section, is the most common predisposing factor. Age and parity are alos related to the incidence of uterine rupture in most series. Ruptures occuring during labor generally involve the lower segment whereas those prior to labor are usually corporal. Symptoms are estremely variable, ranging from none to complete collapse. The amount of intraperitoneal spill, degree of fetal and placental extrusion, condition of the patient, and degree of retraction of the uterine musculature and important factors in symptamatology. The classical clinical picture includes abdominal pain and tenderness, cessation of labor, shock, and vaginal bleeding. Immediate surgical intervention, with institution of appropriate supportive measures to combat shock and hemorrhage, is the cornerstone of treatment of uterine rupture. The choice of surgical procedure depends on the type, extent, and location of the rupture as well as the patient's condition and desire to preserve her childbearing capacity. Hysterectomy is the procedure of choice in cases of spontaneous or traumatic rupture with no uterine scar. It is doubtful that the incidence of spontaneous rupture of the unscarred uterus can be reduced until more is known about its etiology. Traumatic and spontaneous ruptures are most dangerous, with maternal mortality rates of 20% and 8%, respectively. Knowledge of uterine rupture would be significantly enhanced by a collaborative type study collecting data from several institutions over a given time period. |
