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  • Title: The consecutive management of uterine rupture.
    Author: Onyemeh AU, Twomey D.
    Journal: Trop J Obstet Gynaecol; 1988; 1(1):80-1. PubMed ID: 12179278.
    Abstract:
    This study is presented in order to consider and discuss a possible alternative to radical surgery in treating uterine rupture. In the 5 year period, 1981-1985 inclusive, 34 patients had 46 pregnancies and 48 children (2 sets of twins) in Master Misericordiae Hospital, Afikpo following rupture of the uterus. During this period, 14,219 patients were delivered and there were 106 cases of uterine rupture giving an incidence of 7.5/1000 deliveries. The data consisted of 3 groups-- caesarean (27 cases), repeat rupture (4 cases), and vaginal delivery (3 cases). Findings indicated that 16 patients (47.1%) had 1 caesarean section following uterine rupture; 10 patients (29.4%) had 2 caesarean sections following uterine rupture; and 1 patient (2.9%) had 3 caesarean sections following uterine rupture; all patients in this series were booked-except the cases of repeat rupture. The mean age of the patients was 29.6 years and the mean parity was 4.2. In the repeat rupture group, 1 had a rupture of a lower segment scar at 40 weeks; 1 had a rupture of a cornual soar at 22 weeks; and 2 had rupture of upper segment scars--1 at 22 weeks, the other at 36 weeks. In the vaginal delivery group, routine exploration revealed intact uterus. There were 3 cases of abortion giving an incidence of 6.5/1000 pregnancies; 2 were due to a repeat uterine rupture at 22 and 23 weeks. No maternal death was recorded while 6 perinatal deaths occurred (125/1000) in this series. From this review, it is considered that many mothers can carry a pregnancy up to viability with a favorable outcome. The conservative approach to the management of uterine rupture is based on attitudes of the society to the conservation of fertility, the size of the families, the sex of the children, and the high mortality of children in the tropics. Calculated risks can be minimized by proper education of the patient and her husband, by the maintenance of accurate records, by early admission and intervention, and by adequate blood transfusion facilities. We thus conclude that the conservative management of uterine rupture has a place in this environment.
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