Commentary: Ruptured uterus

rupture of the unscarred uterus. The principal difference between the three countries is in the aetiology of the uterine rupture. In Syria 50% of ruptures occurred in a scarred uterus and 50% occurred in an unscarred uterus associated with trauma or spontaneously. In Nigeria 75% occurred in association with a previous section scar and 25% had traumatic factors or were unexplained apart from parity. In Sudan 35% ruptures occurred in a scarred uterus and 65% occurred in an unscarred uterus. These differences may be explained by the availability of medical services or distance from hospital services. In contrast, the results from Ireland, published in the Journal in 1993, one-third of cases occurred in the unscarred uterus and two-thirds occurred in the scarred uterus. There were no maternal deaths but the perinatal mortality rate was 45%. These ® gures would suggest that social and medical improvements in developing countries will signi® cantly improve survival in mothers with ruptured uterus and reduce the perinatal loss by 50%.