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Thirty-six cases of obstetrical rupture of the uterus over a thirty-two-year period at the Woman's Hospital are presented. As over half of these ruptures occurred in patients who had previously been delivered by cesarean section, it therefore seems wiser to pursue a policy of “once a cesarean, always a cesarean.” Granted that some patients with adequate pelves may safely be delivered vaginally following previous cesarean section, this fact, nevertheless, should not give one a sense of false security, as it is no guarantee that the uterus of such a patient will not rupture during a subsequent labor. Other predisposing factors such as previous myomectomies and complicated vaginal deliveries are also discussed and certain recommendations made.

In the 34 years from 1929 to 1962, inclusive, there were 35 cases of rupture of the uterus during pregnancy at the Pennsylvania Hospital. The series is classified according to etiologic factors and is reviewed from the standpoints of age and parity of the patients, time and site of rupture, causes, diagnosis, treatment, and maternal and fetal mortality. The adoption of less traumatic procedures for termination of labor has reduced the incidence of non-cesarean uterine rupture. Gratifying results have been achieved in management of post-cesarean uterine rupture in recent years; during the second half of the 34 year period there were no maternal or fetal deaths in this group.

A case report is presented of a patient operated upon for partial separation of the normally implanted placenta. Massive hemorrhage (3,000 c.c.) occurred within a matter of three minutes after opening the uterus. The placenta had to be removed manually, and it would appear that the uterus was unknowingly ruptured during this procedure. The initial measured blood loss was in excess of one-half the estimated blood volume, and simultaneous replacement of blood and plasma by multiple transfusions during the day of operation represented eight-ninths of the estimated blood volume. The calculated blood volume of the patient at the time of operation was 6,200 cubic centimeters. The total blood loss was estimated at 5,700 cubic centimeters and the replacement of blood and plasma amounted to 7,750 cubic centimeters.

In der Zeit von 1906–1954 wurden an der Landes-Frauenklinik Bochum unter 45183 Geburten 44 Uterusrupturen beobachtet. Das entspricht einer Frequenz von 0,097%.

Two cases are here reported, which were strikingly similar except that, in the second, the bladder itself did not rupture but acted as a tampon to the tear in the uterine lower segment, while, in the first case, rupture of the lower segment into the bladder took place. The second patient had been unwisely allowed to remain in hard labor for several hours before the consultant was called, and rupture had taken place when the patient was first seen by the author.

INFUSION of a dilute solution of pitocin for induction of labor and treatment of uterine inertia is gaining popularity. The purpose of this paper is to report two accidents that occurred in more than 150 such cases on the Tulane Service of the Charity Hospital, New Orleans. One of these cases was previously reported in an account of our experiences with these infusions.¶ A number of precautions have evolved from our use of pitocin infusions. In the preparation of the infusion not more than 10 minims of pitocin (often only 5) is added to a 1000-cc. set. The venoclysis is . . .

Summary 1. A case is presented illustrating the occurrence of uterine rupture of a severe degree without the dramatic symptoms usually associated with this condition. 2. Attention is drawn to the importance of strict observation ot patientsin the “fourth stage of labor” as regards nonresponding blood prcssnre ill the shock levels, with or without excessive vaginal bleeding. 3. The severe degree of the uterine laceration with the minimal symptoms leads one to postulate that many cases of less severe rupture must go unrecognized and be precursors of later, more severe, rupture.