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Near-mortality instances among women facing severe obstetric complications, often referred to as "maternal near-miss" cases, involve situations where women experience life-threatening complications during pregnancy, childbirth, or postpartum but survive due to timely and effective medical interventions. These cases are critical for understanding healthcare gaps, risk factors, and improving maternal health outcomes. The present case series examines five near-miss instances among women experiencing severe obstetric complications. Case 1 details a 28-week primigravida with Dichorionic-Diamniotic twins (DCDA) and severe preeclampsia, leading to an emergency caesarean section. She presented with Haemolysis, Elevated Liver enzymes, Low Platelets syndrome (HELLP), and Disseminated Intravascular Coagulation (DIC). Case 2 involves a 37-year-old Gravida 3 Para 2 Living 0 Abortion1 (G3P2L0A1) woman with 28.5-week In-vitro Fertilisation (IVF)-conceived DCDA twins and a history of a previous Lower Segment Caesarean Section (LSCS), requiring an emergency subtotal obstetric hysterectomy due to Postpartum Haemorrhage (PPH). Case 3 describes a 35-year-old primigravida at 39.4 weeks with a retained placenta, managed through step-wise interventions, which eventually resulted in the spontaneous expulsion of the placenta. Case 4 presents a 32-year-old multigravida at 40.3 weeks with uterine rupture and abruptio placentae, necessitating an obstetric hysterectomy. Lastly, Case 5 involves a 27-year-old female with a scar ectopic pregnancy, treated successfully with methotrexate. These cases underscore the critical need for timely medical interventions and improved maternal healthcare systems to manage life-threatening obstetric emergencies effectively. [ABSTRACT FROM AUTHOR]

Uterine artery embolization (UAE) is an effective minimally invasive alternative to surgery for the treatment of symptomatic uterine fibroids. Uterine rupture is an obstetrical emergency that requires early diagnosis and prompt management to improve perinatal and maternal outcomes.A 33-year-old woman at 37 weeks of gestation who had had previous two uncomplicated vaginal deliveries at term presented with abdominal pain and rupture of membranes. The patient had undergone UAE for the management of a large anterior wall uterine fibroid three years prior to conception. Vaginal examination revealed cord prolapse and ultrasound showed negative fetal heart. Intrauterine fetal demise with cord prolapse was diagnosed. After admission the patient developed vaginal bleeding and features of hypovolemic shock. Urgent laparotomy revealed a ruptured uterus with a large hemoperitoneum and dead fetus in the abdominal cavity.Obstetricians should be attentive to the possibility of a spontaneous uterine rupture in pregnant women who have previously undergone UAE for the management of a uterine fibroid.

Objective: To present a highly rare case series of uterine rupture in primigravida individuals with an unscarred uterus. Case: The unscarred uterus in primigravida patients is supposed to be impervious to rupture, yet we have four cases of ruptured uterus in primigravida patients in our institute over a three-year period (2018-2021). In this case series, the ruptured uterus was discovered in primigravida women with premature labour, obstructed labour, instrumental delivery, and abruptio placentae. In the absence of previous surgery or multiparity, uterine rupture may go unnoticed, resulting in late diagnosis and considerable mortality and morbidity. All four cases required immediate resuscitation and laparotomy; uterine repair was performed in three cases, although a peripartum hysterectomy was needed in one. Conclusion: Rupture uterus can occur even in the unscarred uterus of primigravida patients and early diagnosis and timely management can prevent high maternal mortality and morbidity. [ABSTRACT FROM AUTHOR]

Background: Extirpative uterine surgeries for near-miss events are usually the last resort when other conservative measures fail. Emergency obstetric hysterectomy (EOH) may still have a significant role where there are limited options. Objectives: To determine the prevalence of EOH, the associated factors and the foeto-maternal outcome at the Olabisi Onabanjo University Teaching Hospital, Nigeria. Methods: This was a retrospective observational study covering seven years (January 2010 to December 2016). The case records of patients who had EOH during this period were retrieved for data extraction. Results: There were 5, 608 deliveries and 31 cases requiring EOH giving a prevalence rate of 31/5,608 (0.55%). The mean age of the patients was 30.3±4.2 years, while the mean gestational age at delivery was 36.3±5.1 weeks. Most of the patients 16/25 (64.0%) were of higher parity (>3), and 12/25 (48%) of the patients were within the age bracket of 25-34 years. Subtotal hysterectomy was the most common procedure (18; 72.0%), and ruptured uterus was the main indication for EOH (40.0%). The two most common interventions that were critical to survival included massive blood transfusion (24.0%) and Intensive Care Unit admission (20%). Two (8%) maternal deaths and 58.3% perinatal mortality were recorded. Conclusion: EOH is still relatively frequently performed at this centre due to the high incidence of a ruptured uterus. Efforts should be made to increase the proportion of deliveries attended by skilled personnel and improve the capacity of lower level hospitals for comprehensive emergency obstetric care.

Abstract Background Maternal mortality is a major public health challenge in Ethiopia. Uterine rupture is an obstetrical emergency with serious undesired complications for laboring mothers resulting in fatal maternal and neonatal outcomes. Uterine rupture has been contributing to high maternal morbidity and mortality. However, there is limited research on the factors and management outcomes of women with uterine rupture. Understanding the factors and management outcomes might delineate strategies to support survivors. Therefore the aim of this study is to assess the incidence and factors associated with outcomes of uterine rupture among laboring mothers at Felegehiwot Referral Hospital in Bahir Dar City, Northwest Ethiopia. Methods This is a cross sectional study with retrospective facility based data collection technique. All pregnant women who were managed for ruptured uterus at Felegehiwot referral hospital from September 11 2012 to August 30 2017 were included. The chart numbers of the women collected from operation theatre registers. Their case folders retrieved from the medical records room for analysis. Using structured check list, information on their sociodemography, booking status, clinical features at presentation and the place of attempted vaginal delivery was extracted. Data on the intraoperative findings, treatment, and associated complications and outcomes also collected. The collected data cleaned, coded and entered into EPI- Info version (7.1.2.0) and then exported in to SPSS Version 20.0 for analysis. Statistical comparison was done using chi square (X2). Strength of association between the explanatory variables and outcome variables described using odds ratio at 95% CI and P value less than 0.05. The results presented in tables. Results We studied 239 cases of uterine rupture in the 5 years period. Mothers without previous cesarean delivery including eight primigravidas took 87% of the cases. From all study participants, 54 of mothers (22.6%) developed undesired outcomes whereas 185(77.4%) discharged without major sequel. More than half (56.9%) arrived in hypovolemic shock. Total abdominal hysterectomy was the commonest procedure accounting for 61.5%. Duration of surgery was less than 2 h in 67.8% of the procedures. Anemia is the commonest complication (80.3%) followed by wound infection and VVF (11.7% each). There were 5 maternal deaths (2.1%). Mothers who had prolonged operation time (> 2 h) (AOR: 2.2, 95% CI: 1.10, 4.63) were significantly associated with undesired maternal outcomes after management of uterine rupture. Conclusion Incidence of ruptured uterus and its complications were high in the study area. It reflects the need for improvement in obstetric care and strong collaboration with referring health facilities to ensure prompt referral and management.

BACKGROUND: Unbooked emergencies are major reasons for the high maternal and perinatal mortality and morbidity in Nigeria. Rupture of the gravid uterus in women without antenatal care usually present late to hospital as unbooked emergencies with high perinatal deaths and very poor maternal outcome. AIM: To determine the factors implicated in the poor feto-maternal outcome with ruptured uterus amongst the unbooked mothers at the University of Port Harcourt Teaching Hospital(UPTH). METHOD: A retrospective analysis of case records of 82 consecutive patients without antenatal care who had ruptured uterus between January 2008 and December 2012. RESULT: There were 2133 deliveries among unbooked mothers at the University of Port Harcourt Teaching Hospital over this 5-year period. The incidence of ruptured uterus for the period under review was 3.8%. The mean age was 28.1years and the modal parity was 2. Abdominal massage and prolonged obstructed labor were the commonest predisposing factors, occurring in 43.9% and 34.1% of these women respectively. There were 80 perinatal deaths contributing to 12.2% of the perinatal mortality rate. There were 6 maternal deaths from ruptured uterus which was 10.9% of the maternal mortality ratio of 2578.5 per 100,000 live birth during the study period. CONCLUSION: Perinatal and maternal mortality rates from ruptured uterus were high. The major causes of uterine rupture are abdominal massage and prolonged obstructed labor, which are both preventable. Public enlightenment and condemnation of practices that promote these factors is advocated.

Abstract Background Maternal mortality and morbidity are the priority agenda for sub-Saharan Africa including Ethiopia. Uterine rupture is the leading cause of maternal and fetal death in developing countries. Limited evidence is available on the magnitude of uterine rupture; maternal and fetal outcomes of uterine rupture and factors associated with maternal death secondary to uterine rupture in Ethiopia. This study aimed to assess the magnitude of uterine rupture; maternal and fetal outcome of uterine rupture and factors associated with maternal death secondary to uterine rupture in Debremarkos Referral Hospital, Northwest Ethiopia. Methods An institutional-based cross-sectional study was conducted in December 2015 in Debremarkos referral hospital, Northwest Ethiopia. A total of 242 records of mothers with uterine rupture at Debremarkos referral Hospital during the year 2011–2014 were included in the study. Secondary data was collected from the records of mothers admitted for the management of uterine rupture. Descriptive statistics were performed to characterize the study population. Bivariate and multivariable logistic regression model was fitted to identify factors associated with maternal death secondary to uterine rupture. Odds ratio with 95% confidence interval was computed to determine the level of significance. Results A total of 10,379 deliveries were attended A total of 242 uterine rupture cases were included in this study. The magnitude of uterine rupture was 2.44% (1 in 41 deliveries). Sixteen (6.6%) mothers died from uterine rupture. Fourteen (5.8%) had experienced Vesico Vaginal Fistula. The majority of the mothers, 72% (176), admitted for uterine rupture stayed in hospital for 6–10 days. Fetal outcome was grave, 98.3% (238) were stillborn. Place of labor [Adjusted odds ratio (AOR): 6.92, 95% confidence interval (CI): (1.16, 33.74)], occurrence of hypo volume shock [AOR: 3.48, 95% CI: (1.01, 11.96)] and postoperative severe anemia [AOR: 0.092, 95% CI: (0.01, 0.956)] were significantly associated with maternal death secondary to uterine rupture. Conclusion The magnitude of uterine rupture was high in the study area. Initiation of labor at health institutions, early treatment of hypo-volumia and prevention of postoperative anemia is recommended to decrease maternal death secondary to uterine rupture.

Background: Unlike pregestational diabetes mellitus, the American College of Obstetricians and Gynecologists recommends antenatal corticosteroids in those with gestational diabetes mellitus at risk for preterm birth. However, this recommendation is based on limited data, only 10.6% of the Antenatal Late Preterm Steroids study sample had gestational diabetes mellitus. There is a paucity of data on the risk of neonatal respiratory and other morbidity in this population., Objective: This study aimed to examine respiratory outcomes in parturients with gestational diabetes mellitus who received antenatal corticosteroids and delivered during the late preterm period vs those who did not., Study Design: This population-based cohort study used the US Vital Statistics dataset between 2016 to 2020. The inclusion criteria were singleton, nonanomalous individuals who delivered between 34.0 to 36.6 weeks with gestational diabetes mellitus and known status of antepartum corticosteroid exposure. The primary outcome, a composite neonatal adverse outcome, included Apgar score <5 at 5 minutes, immediate assisted ventilation, assisted ventilation >6 hours, surfactant use, seizure, or neonatal mortality. The secondary outcome was a composite maternal adverse outcome, including maternal blood transfusion, ruptured uterus, unplanned hysterectomy, and admission to the intensive care unit. Multivariable Poisson regression models were used to estimate adjusted relative risks and 95% confidence intervals. Average annual percent change was calculated to assess changes in rates of corticosteroid exposure over the study period., Results: Of 19 million births during the study period, 110,197 (0.6%) met the inclusion criteria, and among them, 23,028 (20.9%) individuals with gestational diabetes mellitus received antenatal corticosteroids. The rate of antenatal steroid exposure remained stable over the 5 years (APC=10.7; 95% confidence interval, -5.4 to 29.4). The composite neonatal adverse outcome was significantly higher among those who received corticosteroids than among those who did not (137.1 vs 216.5 per 1000 live births; adjusted relative risk 1.24; 95% confidence interval, 1.20-1.28). Three components of the composite neonatal adverse outcome-immediate assisted ventilation, intubation >6 hours, and surfactant use-were significantly higher with exposure than without. In addition, the composite maternal adverse outcome was significantly higher among those who received corticosteroids (adjusted relative risk, 1.34; 95% confidence interval, 1.18-1.52). Three components of the composite maternal adverse outcome-admission to intensive care unit, blood transfusion, and unplanned hysterectomy-were significantly higher among the exposed group. Subgroup analysis, among large for gestational age, by gestational age, and race and ethnicity, confirm the trend of increased likelihood of adverse outcomes with exposure to corticosteroid., Conclusion: Individuals with gestational diabetes mellitus and antenatal corticosteroid exposure, who delivered in the late preterm, were at higher risk of neonatal and maternal adverse outcomes than those unexposed to corticosteroid., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Primary postpartum haemorrhage (PPPH) is the leading cause of maternal morbidity and mortality in low resource countries like Pakistan. The objectives of this study were to determine the frequency, distribution by place of delivery and parity, causes, management options and outcome of PPPH in postpartum women of District Peshawar, Pakistan. Materials & Methods: This cross-sectional study was conducted in Department of Gynaecology & Obstetrics, Lady Reading Hospital, Peshawar, Pakistan from 1st January 2019 to 30th June 2019. Sample size of 4,034 was with 0.39342% margin of error, 95% confidence level, prevalence of PPPH 2% and a population of 23,607 postpartum women. All postpartum women were eligible. Those with secondary PPH, surgical management for PPPH done at some other hospital, with known bleeding disorders and on anticoagulants were excluded. All these patients were managed according to standard protocols. Data was collected for following variables; presence of PPPH (yes/no), place of delivery (in-hospital deliveries/referred cases), parity (primipara/multipara/grandmultipara), causes of PPPH (uterine atony/retained placenta-RPOC/ruptured uterus/genital tract tears), management options of PPPH (conservative management/laparotomy with repair of ruptured uterus/laparotomy with uterine artery ligation and B-Lynch/repair of genital tract tears other than ruptured uterus/removal of retained placenta & RPOC/hysterectomy) and outcome of PPPH (uneventful recovery/maternal near miss/maternal mortality). Frequencies and percentages with confidence intervals were calculated for these variables. Results: Out of 4034 postpartum women, frequency of PPPH was 400 (9.92%). Out of 4034 women, distribution of 400 cases of PPPH by place of delivery was 222 (5.50%) in-hospital deliveries and 178 (4.42%) referred cases and by parity it was primipara 79 (1.96%), multipara 243 (6.03%) and grandmultipara 78 (1.93%) cases. Out of 400 cases of PPPH, frequency of uterine atony was 254 (63.50%) and conservative management 245 (61.25%). Out of 400 cases, frequency of uneventful recovery was 352 (88%), maternal near miss 40 (10%) and maternal mortality eight (2%) cases. Conclusion: Primary postpartum haemorrhage (PPPH) continues to be a common and serious complication of delivery with uterine atony being its most predominant cause. [ABSTRACT FROM AUTHOR]

Every day, approximately 830 women die from preventable causes related to pregnancy and childbirth. Ninety-nine percent of all maternal deaths occur in developing countries. Its incidence is higher in women living in rural areas and among poor communities, according to the World Health Organization (WHO) in 2015. The objective of this case report is to highlight the problem of maternal deaths in the Transkei region of South Africa. A 31-year-old woman was brought to hospital with a history of bleeding vaginally. She was not complaining of labor pain, only of bleeding profusely. When the patient collapsed, cardiorespiratory resuscitation (CPR) was started, and the patient was defibrillated. Intubation was carried out and IV adrenaline was given, but there were no signs of recovery. Resuscitation was called off, and the patient was declared dead. The patient was the mother of five children. She had delivered four children vaginally, and one by caesarean section. At autopsy, the woman was found to be obese and pale. There was a copious amount of blood in the peritoneal cavity. A full-term mature fetus was floating on the umbilical cord, and lower segment of the uterus was found ruptured. The history, pathophysiology and cause of death are discussed in this report. Preventive measures are suggested. In conclusion, the incidence of maternal death is unacceptably high in the Transkei region. The matter needs urgent attention. [ABSTRACT FROM AUTHOR]

We are reporting a case of a ruptured uterus at the uterine fundus at 16 weeks of gestation in a 27-year-old, gravida 3 para 2 patient with a history of two previous cesarean sections. She presented to the emergency department with sudden onset of severe abdominal pain and signs of shock. Urgent transabdominal ultrasound showed intraperitoneal fluid with blood clots and a myometrial defect at the uterine fundus. The patient was taken directly to theater for an exploratory laparotomy. A perforation at the uterine fundus was found through which a part of the placenta was protruding. A Supracervical hysterectomy was done, histopathology showed placenta percreta. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality and morbidity are the priority agenda for sub-Saharan Africa including Ethiopia. Uterine rupture is the leading cause of maternal and fetal death in developing countries. Limited evidence is available on the magnitude of uterine rupture; maternal and fetal outcomes of uterine rupture and factors associated with maternal death secondary to uterine rupture in Ethiopia. This study aimed to assess the magnitude of uterine rupture; maternal and fetal outcome of uterine rupture and factors associated with maternal death secondary to uterine rupture in Debremarkos Referral Hospital, Northwest Ethiopia.Methods: An institutional-based cross-sectional study was conducted in December 2015 in Debremarkos referral hospital, Northwest Ethiopia. A total of 242 records of mothers with uterine rupture at Debremarkos referral Hospital during the year 2011-2014 were included in the study. Secondary data was collected from the records of mothers admitted for the management of uterine rupture. Descriptive statistics were performed to characterize the study population. Bivariate and multivariable logistic regression model was fitted to identify factors associated with maternal death secondary to uterine rupture. Odds ratio with 95% confidence interval was computed to determine the level of significance.Results: A total of 10,379 deliveries were attended A total of 242 uterine rupture cases were included in this study. The magnitude of uterine rupture was 2.44% (1 in 41 deliveries). Sixteen (6.6%) mothers died from uterine rupture. Fourteen (5.8%) had experienced Vesico Vaginal Fistula. The majority of the mothers, 72% (176), admitted for uterine rupture stayed in hospital for 6-10 days. Fetal outcome was grave, 98.3% (238) were stillborn. Place of labor [Adjusted odds ratio (AOR): 6.92, 95% confidence interval (CI): (1.16, 33.74)], occurrence of hypo volume shock [AOR: 3.48, 95% CI: (1.01, 11.96)] and postoperative severe anemia [AOR: 0.092, 95% CI: (0.01, 0.956)] were significantly associated with maternal death secondary to uterine rupture.Conclusion: The magnitude of uterine rupture was high in the study area. Initiation of labor at health institutions, early treatment of hypo-volumia and prevention of postoperative anemia is recommended to decrease maternal death secondary to uterine rupture. [ABSTRACT FROM AUTHOR]

This study determined the incidence, obstetric morbidity and the socio-cultural factors associated with ruptured uterus. A 6-year prospective review of ruptured uterus and an enquiry into socio-cultural barriers to specialised care was conducted. The incidence of ruptured uterus was 12 per 1000 deliveries. Occurrence was common in uneducated (78/116; 67.2%), unbooked (110/116; 94.8%) and rural women (112/116; 96.6%). The major causes were prolonged obstructed labour (104/116; 89.7%) and injudicious use of oxytocics (90/116; 77.6%). The maternal and perinatal case fatality rates were 18.1% and 96.6%, respectively. Complications resulted from haemorrhage and sepsis. Lack of birth plan (97/116; 79.3%) and unskilled birth attendance (110/116; 94.8%) were major socio-cultural risk factors. There was an association between education (p = 0.001), parity (p = 0.002), residence (<0.001), type of birth attendance (<0.001) and ruptured uterus. Women in low-income settings face threats of complications and death from uterine rupture, owing to preventable socio-cultural barriers of accessing specialised obstetric care. [ABSTRACT FROM PUBLISHER]

OBJECTIVE: To determine the frequency of maternal mortality and identify causes with age groups in tertiary care hospital of Peshawar, Pakistan. METHODOLOGY: A descriptive study conducted at Gynecology & Obstetrics units of Lady Reading Hospital, Peshawar, Pakistan. with retrospective review of validated records of hospital registers from January 1st January 2009 to 31st December 2011. Convenience sampling used to access the records. A self structured proforma designed to collect validated data on variables (age, cause of death, year of death, place of residence), that were analyzed in Excel- 2007 and trend analysis determined by Joinpoint Analysis Software. RESULT: A total of 277 maternal deaths recorded from Lady Reading Hospital in three years. Hemorrhage remains the leading cause with 27.07% (CI= 0.66, SD= 5.65) followed by eclampsia 15.88 % (CI= 0.60, SD= 5.13), ruptured uterus 10.83% (CI= 0.51, SD= 4.35) and sepsis 10.10% (CI= 0.47, SD= 4.04). Maximum maternal deaths of 33.57 % reported in 26- 35 years, followed by 26.71 % in 15- 25 years, 23.10 % in 36- 45 years and 3.24 % in 45- 55 years and 6.13 % deaths reported from unknown age group as well. Post Partum hemorrhage was significant with P-value (0.002). CONCLUSION: Maternal mortality remains high with leading causes as hemorrhage, eclampsia, ruptured uterus and sepsis in women of 26-35 years age groups. A strong need to improve the maternity care in tertiary care hospitals and community based education is emphasized for the awareness of the masses, to prevent these deaths. [ABSTRACT FROM AUTHOR]

Background: Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy that becomes implanted at the site of a previous cesarean section scar. It may lead to horrible consequences, such as uncontrolled bleeding and uterine rupture (UR), which might require hysterectomy and result in subsequent loss of fertility. Case: This report covers a case of a CSP complicated by UR at 10 weeks gestation in a 25-year-old woman after development of an acute abdomen. Conservative management of the uterus was used, with removal of the sac and repair of the uterine scar. Results: The patient's postoperative period was uneventful, and she was discharged 5 days after her surgery had occurred. Conclusions: CSP should be detected early to prevent its catastrophic sequences. Although it is a rare complication of cesarean section, CSP must be kept in the minds of obstetricians facing emergency cases. (J GYNECOL SURG 33:261) [ABSTRACT FROM AUTHOR]

Background: Emergency hysterectomy in obstetric practice is generally performed in the setting of life-threatening hemorrhage which fails to be controlled by conservative management. Objective: To review 8 years' experience of emergency obstetric hysterectomy in a teaching hospital. Study Design: A retrospective descriptive study based on hospital data of 156 patients undergoing emergency Obstetric hysterectomy. Settings: Obs. & Gynae. Department Unit-I, PMC Allied Hospital Faisalabad. Methods: This was a retrospective review carried out from March 2004 to Feb 2012 Main outcome measures were frequency, indications, associated risk factors and maternal morbidity and mortality associated with emergency peripartum/obstetric hysterectomy. Results: During 8 years there were total 156 (0.38%, 3.8 per 1000) emergency obstetric hysterectomies out of which there were 46 caesarian hysterectomies, 65 post partum, 45 for ruptured uterus with total number of delivery 40062. Number of hysterectomies was 48 in the first 4 years of the study (March 2004- Feb 2008) and during the last 4 years (March 2008- Feb 2012) it was 108. Maximum obstetric hysterectomies were in para 3-5 (53.20%) and in 26-30 years age group (35.89%). The most common indication for hysterectomy was uterine atony (44.23%) followed by uterine rupture (28.85%), Placenta accreta (14.745%) and placenta previa (11.53%). The maternal mortality was 6.41% (10 patients). In this series 80% patients were referred from other areas. Conclusions: Frequency of emergency Obstetric hysterectomy is high in our tertiary center and it is continuously increasing due to increased referral of patients. The mortality and morbidity of performing obstetric hysterectomy is higher in patients referred from outside hospital. [ABSTRACT FROM AUTHOR]

The article presents a study of the role of emergency obstetric hysterectomy in reducing maternal death rate, focusing on a retrospective review of 25 cases of emergency hysterectomy to understand the incidence, indications, and postoperative complications. It mentions postpartum haemorrhage (PPH) caused by uterine atony not responding to medical management and uterus rupture as the most common indication for the surgery, highlighting the importance of proper antenatal and early referral.

Reducing maternal mortality constitutes one of the eight Millennium Development Goals. While significant progress has been made, system issues and professional training continue to affect maternal survival, especially when unusual, but deadly, complications arise. This rare case of survival after the rupture of an unscarred uterus in a grand multiparous woman from a remote village in Ghana illustrates how systemic transportation issues and limited access to advanced medical care put women with obstetric complications at risk. The usual clinical presentation of ruptured uteri and methods to prevent this catastrophic event are discussed. This case illustrates the systemic transportation issue that often limits access to prenatal and emergency care throughout much of the developing world and demonstrates how advanced training for emergency nurses and the use of ultrasound diagnosis can expedite difficult diagnoses and lead to maternal survival, even in the most adverse circumstances

Background: Ruptured uterus is an obstetric catastrophe and results in significant maternal and perinatal morbidity and mortality in Nigeria. Methods: To review the incidence and management of ruptured uterus over the 8-year period (2000-2004 and 2007-2009) and analysis of records of cases of ruptured uterus during the period under review in a descriptive study. Results: The incidence of uterine rupture is 1 in 81 deliveries with a contribution of 13.8% to maternal mortality in Ebonyi State University Teaching Hospital, Nigeria. There was high fetal wastage as 99 (97.1%) of the babies died. The highest incidence of ruptured uterus was found in the para 2-4 group. Teenagers constituted 4 (3.96%) of the cases. Majority of the rupture, 69 (65.4%) occurred anteriorly. Fifty-seven (56.4%) had only repair of the rupture done. The greatest complication was septicemia, which occurred in 32 (31.7%) of the patients. Conclusion: The incidence of uterine rupture is very high in our center. It is one of the highest causes of maternal and perinatal morbidity and mortality. There should be a multi-pronged effort aimed at improving the utilization of medical services by the populace and the health institutions offering efficient obstetric emergency care. [ABSTRACT FROM AUTHOR]

Objective. To determine the incidence of ruptured uterus as well as the clinical profile and management options in a tertiary hospital setting. Methods. Thirty-three cases of ruptured uterus managed at University of Benin Teaching Hospital (UBTH) from 1 January 2003 to 31 December 2007 were identified and retrospectively studied. Results. The incidence of ruptured uterus was 4.2 per 1000 deliveries (0.4%%). Majority (87.9%%) of the patients were unbooked. Injudicious use of oxytocics (63.7%%) and prolonged obstructed labor (60.6%%) were the main associated risk factors. All 33 patients had laparotomy and 51.2%% had repair of the uterine rupture only. The type of surgery performed was influenced by the site and extent of rupture. There were two cases of maternal deaths in this study, giving a case fatality rate of 6.1%%. Conclusion. Rupture of the gravid uterus is still a problem in Nigeria. A proactive approach to preventing prolonged obstructed labor and curbing the injudicious use of oxytocics through education and utilization of modern antenatal and intrapartum care is advocated. [ABSTRACT FROM AUTHOR]

Reducing maternal mortality constitutes one of the eight Millennium Development Goals. While significant progress has been made, system issues and professional training continue to affect maternal survival, especially when unusual, but deadly, complications arise. This rare case of survival after the rupture of an unscarred uterus in a grand multiparous woman from a remote village in Ghana illustrates how systemic transportation issues and limited access to advanced medical care put women with obstetric complications at risk. The usual clinical presentation of ruptured uteri and methods to prevent this catastrophic event are discussed. This case illustrates the systemic transportation issue that often limits access to prenatal and emergency care throughout much of the developing world and demonstrates how advanced training for emergency nurses and the use of ultrasound diagnosis can expedite difficult diagnoses and lead to maternal survival, even in the most adverse circumstances. [ABSTRACT FROM AUTHOR]

We compared the outcomes of bloodless emergency laparotomies for uterine rupture in twenty Jehovah’s Witness (JW) women who were in a state of haemorrhagic shock with 45 other women who received blood transfusion. The case records of twenty Jehovah’s Witness patients, who underwent bloodless emergency laparotomies for ruptured uterus complicated by haemorrhagic shock between 1 January 2000 and 31 December 2006 were reviewed. We also reviewed the case records of 45 other patients who underwent similar surgical procedures for similar indications and in whom blood was transfused. The outcome variables compared were maternal deaths, infectious morbidity, acute respiratory distress syndrome, disseminated intravascular coagulation, length of post laparotomy ventilatory support, and length of postpartum hospitalization. Demographic and obstetric characteristics were similar in both groups. Seventeen out of the twenty Jehovah’s Witness patients who refused blood transfusion survived the laparotomies and were discharged home in good condition. Three died of peritonitis. Six out of the 45 patients who received blood transfusion also died of peritonitis and one died of disseminated intravascular coagulopathy. The average duration of post partum hospitalization was 8 days in the group of patients transfused and 7 days in the group not transfused. Disseminated intravascular coagulation occurred post partum in two of the patients transfused. No case of acute respiratory distress syndrome or amniotic fluid embolism was identified in either group. Patients who are in haemorrhagic shock from ruptured uterus and refuse blood transfusion can still be salvaged in a low resource setting. The study adds evidence that major operative procedures can be carried out on Jehovah’s Witness patients without blood transfusions or blood products. [ABSTRACT FROM AUTHOR]

Aim: To determine the etiologic factors, clinical presentation, management and fetomaternal outcome in cases of rupture of the gravid uterus and propose preventive measures. Methods: A retrospective analysis of cases of uterine rupture was carried out at B.P. Koirala Institute of Health Sciences, Nepal, between February 1999 and January 2004. Results: There were 126 cases of uterine rupture with incidence of one in 112 deliveries. Twenty-five patients (19.8%) had a cesarean scar. Obstructed labor was the common antecedent factor in the unscarred group (46.5%) and use of oxytocics accounted for maximum ruptures (44%) in the scarred category. Patients with an unscarred uterus presented with hypotension and intrauterine death (89.1%), while abdominal tenderness (76%) and fetal distress (64%) were common modes of presentation in the scarred category. Complete rupture was seen in 84.9% of patients. Lateral wall ruptures (71.3%) necessitating hysterectomy (75.2%) were seen in the unscarred group. Anterior ruptures (92%) and repair (84%) were common in the scarred category. Maternal mortality was 13.5% and perinatal mortality 83.3%; these were both higher in the unscarred uterus. Conclusion: The incidence of uterine rupture is high in Eastern Nepal and rupture of the unscarred uterus carries graver risks. Regular antenatal care, hospital deliveries and vigilance during labor with quick referral to a well-equipped center will reduce the incidence of this condition. [ABSTRACT FROM AUTHOR]

Unsafe abortion has a global incidence of about 20 million cases annually, out of which 97% cases are reported from developing nations. There are many reports showing the occurrence of bowel or uterine perforation in such instances, but most of them have concentrated upon surgical or obstetric complications. We report a case of unsafe abortion with ruptured uterus, intra-abdominal foetus, and bowel infarction that developed intraoperative cardiac arrest during the emergency laparotomy. This case highlights anaesthetic challenges in managing such critically ill-patients. [ABSTRACT FROM AUTHOR]

The authors report a rare occurrence of a chronic abdominal pregnancy secondary to a ruptured bicornuate uterus. It is unusual in that rupture of the uterine horn probably occurred 2 weeks prior to diagnosis. Management was laparotomy to remove the fetus with resection and repair of the uterus. Uterine anomalies, their imaging and diagnosis, as well as the patient's subsequent reproductive prognosis are discussed. [ABSTRACT FROM AUTHOR]

Background. Ruptured uterus is a common obstetric emergency in Nigeria, associated with high maternal and perinatal morbidity and mortality. There is a need for definitive identification of the risk factors to guide effective interventions to curb its scourge. Objective. To identify the sociodemographic and obstetric risk factors for ruptured uterus in Benin City, Nigeria, and based on this, make appropriate recommendations toward curbing the incidence and morbidity and mortality associated with it. Materials and methods. Sociodemographic and obstetric variables in 51 women with ruptured uterus and 300 randomly selected hospital controls from the general obstetric population were compared. Fisher's exact test was used to determine statistical significance between proportions. Results. The incidence of ruptured uterus was 1 in 426 deliveries. The risk factors found were low socioeconomic class (OR = 6.8, Cl = 3.6-12.9), being unbooked for antenatal care (OR = 10.4, Cl = 5.4-20.0), grand multiparity (OR = 8.7, CI = 4.0-19.1), and prolonged obstructed labor (OR = 35.3, CI = 15.3-81.6). conclusion. Measures that promote education and economic empowerment of women and the utilization of modern antenatal care will reduce the prevalence of rupture of the uterus in the community. [ABSTRACT FROM AUTHOR]