Rupture utérine sur utérus sain gravide. À propos de 28 cas

By presentation of cases of spontaneous (nontraumatic) ruptures of previously intact uteri, we sought to emphasize important aspects of this rare and dangerous event. Two case presentations of oxytocin-associated unscarred uterine rupture and review of pertinent literature are used to study risk factors and accompanying clinical characteristics. Both spontaneous ruptures of previous unscarred uteri were associated with low-dose oxytocin augmentation, bradycardia, and uterine hyperstimulation monitor patterns and occurred at the onset of the second stage of labor. Because of its rarity, further investigation of spontaneous uterine rupture will depend on case presentations where the associated events listed are noted and uterine hyperstimulation, fetal bradycardia, and second-stage onset are proved or disproved as valid clinical associations.

Rupture of a pregnant uterus occurs most often in a scarred uterus, and spontaneous rupture of a non-scarred uterus in the early second trimester is rare. A woman with two previous normal vaginal deliveries and no prior trauma to the uterus presented at 16 weeks' gestation with an acute abdomen due to intraperitoneal hemorrhage. A large rupture of the fundus of the uterus was found. A supracervical hysterectomy was carried out, with subsequent good recovery. The specimen showed placenta percreta. Spontaneous rupture of an unscarred uterus, due to placenta percreta, should be considered in cases of acute intraperitoneal hemorrhage, even in early pregnancy.

To determine the incidence, aetiology, trend, management maternal and fetal outcome of uterine rupture at University of Ilorin Teaching Hospital, Ilorin, Nigeria. To compare the results with previous reports from this centre. A prospective study of patients with ruptured uterus at the University of Ilorin Teaching Hospital, Ilorin, Nigeria between February, 1992 and December, 1999 was undertaken. The patients were initially assessed in the labour ward where the clinical presentation, relevant socio-demographic data, previous medical and surgical histories were noted. Necessary investigations and resuscitation were carried out before the operation. A structured questionnaire was also administered either before or after the operation. Two consecutive spontaneous vaginal deliveries following each case of uterine rupture served as control. Statistical analysis was done using the Genstat 32 package. Of the 20,960 deliveries during the study period, there were 100 ruptured uteri giving a hospital incidence of 1 in 210 deliveries. Oxytocin use (39%), uterine scar (23%) and obstructed labour (16%) were the common associated factors. When compared with the controls, uterine rupture in the study group was significantly associated with low socio-economic status p < 0.001, lack of antenatal care p < 0.001, and high parity p < 0.012. A maternal age 40 years and above was also a risk factor. The anterior wall of the uterus was the commonest site affected and repair with tubal ligation was the surgical procedure in 36% of cases. Maternal mortality was 13%, while fetal mortality was 92%. When compared with the previous incidence of 1 in 298 deliveries, a slight increase is noted. Ruptured uterus is still a common obstetric hazard in our environment and its incidence appears to be on the increase. The condition is significantly associated with advanced maternal age, grandmultiparity, lack of antenatal care and the low socio-economic status of the patients.