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Aim: This systematic review is planned to analyse the studies investigating the uterus rupture complication in women who gave a vaginal birth after caesarean section. Research Question: What is the incidence of uterus rupture during a vaginal birth after caesarean section in women under the age of 35 with a single fetus under 4000 gr and a history of caesarean section? Databases: Google Scholar, National Academic Network and Information Centre, Pubmed. Method: 4305 results, published between the dates of 2008 and 2011 and obtained through an electronic search from Google Scholar and National Academic Network and Information Centre, were reviewed between the dates of 18 and 23/12/2012. Summaries of 103 results, which were free of charge and could be obtained in full text, out of 588 results obtained as a result of the search from Pubmed database were reviewed. Five articles from these articles which provided the rate of uterine rupture in vaginal birth after caesarean section were included in the scope of the study. Findings: Studies, included in the scope of the review, determined that the majority of women were under the age of 35. It was figured out that the rate of vaginal birth in women with a history of a previous caesarean section varied from about 34% to 95% and the rate of uterus rupture in these births was 0.9%. Conclusion: Vaginal birth after a caesarean section is considered as a practicable and acceptable method for carefully selected cases, in clinics with adequate equipment and good care conditions, with the approval of families. Ozet Amac: Bu sistematik inceleme, sezaryen sonrasi normal vajinal dogum yapan kadinlarda uterus ruptur komplikasyonunu inceleyen calismalari analiz etmek amaciyla planlanmistir. Arastirma Sorusu: 35 yas alti, tahmini 4000 gr altinda ve tek fetus olan, tek sezaryen gecirmis olan kadinlarda, sezaryen sonrasi vajinal dogumda uterus rupturu gorulme oranlari nedir? Veri Tabanlari: Google Akademik, Ulusal Akademik Ag ve Bilgi Merkezi, Pubmed. Yontem: 18-23/12/2012 arasindaki tarihlerde, 2008-2012 yillari arasinda yayinlanmis olan, Google Akademik ve Ulusal Akademik Ag ve Bilgi Merkezinden yapilan e lektronik arama ile 4305 adet sonuc incelendi. Pubmed veri tabaninda yapilan aramada 588 adet makaleden, ucretsiz ve tam metin alinabilen, dili Ingilizce olan 103 adet sonucun ozetleri incelenmistir. Bu makalelerden sezaryen sonrasi vajinal dogum uygulamasi yapilan, uterus rupturu oraninin verildigi bes adet makale calisma kapsamina alinmistir. Bulgular: Inceleme kapsamina alinan calismalarda kadinlarin cogunlukla 35 yasin altinda oldugu belirlenmistir. Onceden sezaryen olan kadinlarda vajinal dogum oraninin yaklasik %34 ile %95 arasinda degistigi ve bu dogumlarda uterus rupturu oranini en fazla %0.9 oldugu gorulmustur. Sonuc: Sezaryen sonrasi vajinal dogum, dikkatli secilmis olgularda, anne icin yeterli donanim ve iyi bakim kosullarinin oldugu kliniklerde, ailenin de onayi alinarak uygulanabilir ve kabul edilebilir bir yontem olarak gorulmektedir.

The authors report a case of spontaneous uterine rupture in a patient with no risk factor. The break was initially silent and incomplete. Then, because of profuse bleeding was subjected to subtotal hysterectomy and is now in good health. Histological examination revealed severe dysplasia with necrosis of the coating of the esocervix . The authors conclude by stressing the importance of diagnostic assessment of the cervix in pregnancy is to prevent cervical cancer, to eliminate a rare risk factor for uterine rupture during labor.

Background: The incidence of uterine rupture is high in most developing countries and it is a leading cause of maternal mortality and morbidity. Objectives:To determine the incidence, aetiology and the associated morbidity and mortality in cases of ruptured uterus presenting at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Materials and Methods: A review of all the case notes of patients that were managed for uterine rupture over a 7-year period was conducted. The records were analysed for the patients' mode of presentation, possible predisposing factors, type of uterine rupture, and the associated morbidity and mortality. Results: The incidence of rupture during the period was 1 in 67 deliveries or 14.9 per 1000 deliveries. The mean age [SD] was 30.1 [1.8] and the mean parity was 3.3 [0.93]. Majority (88.5%) of the patients were unbooked. Oxytocin administration was the identified aetiological factor in 41 (67.2%) of the patients. Majority (73.8%) presented with clinical signs of shock. At operation, 56 (91.8%) were found to have complete uterine rupture, with a predominance of anterior wall rupture (83.6%). Uterine repair with or without bilateral tubal ligation was the usual surgical treatment offered while wound sepsis, with or without generalized septicaemia, was the commonest morbidity found. Maternal mortality was 14.8%. Conclusion: Uterine rupture continues to be a major cause of maternal morbidity and mortality in Sagamu and efforts should be geared towards reducing the number of women affected by this problem. Key Words: Uterus Rupture, Genital Injury, Haemorrhage, Shock [Trop J Obstet Gynaecol, 2003, 20: 137-140]

In the work presented here, obstetric management after a previous caesarean section was studied in a large patient group at the University Department of Gynecology and Obstetrics in Cologne from 1979 to 1995. Particular attention was given to the feared complication of uterine rupture. From a total of 15 166 deliveries, 1086 of the births had been preceded by one or more caesarean sections. These 1086 births formed the basis for the present study. Vaginal delivery was attempted in 44.5% of patients and was successful in 86% of those cases. Where there had been only one previous caesarean section, the percentage shifted in favor of vaginal delivery. All patients with more than two previous caesarean sections were delivered by elective caesarean section. The feared complication of rupture of the uterus occurred in four cases, for which case reports are presented. In view of such cases, signs of imminent uterus rupture often constitute an indication for elective (11.5%) or emergency resectioning (31.9%). No relationship was found between fetal outcome and mode of delivery. This retrospective study confirms the general recommendation and safety of vaginal delivery after a previous caesarean section as long as risks are minimised by a readiness to proceed with a repeat caesarean when signs of imminent rupture of the uterus arise.

A year after a fundal myomectomy performed as day surgery, a 39-year-old primigravida presented with complete uterine rupture at 36 weeks of gestation. A dead female baby was found lying below the diaphragm and a lot of blood was found inside the abdominal cavity. The uterus was repaired. A year later, another spontaneous pregnancy ensued. A healthy female baby weighing 2100g was delivered by elective cesarean section at 34 weeks. Careful hospital management and scheduled elective cesarean delivery could be a way of achieving a favorable outcome.

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.

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.