title: A Case Series of Uterine Rupture: Lessons to be Learned for Future Clinical Practice.
abstract: OBJECTIVE
  In this article, we try to discuss risk factors and diagnostic difficulties for uterine rupture.
  
  
  METHODS
  Case series of 12 cases of uterine rupture observed in the Norfolk and Norwich University Hospital in the UK, with an average yearly birth rate of 6,000 deliveries, over a 6-year period.
  
  
  RESULTS
  In the present case series, there was no maternal mortality, and uterine rupture was a rare occurrence (12 in 36,000 births). Uterine rupture is associated with clinically significant uterine bleeding, fetal distress, expulsion or protrusion of the fetus, placenta or both into the abdominal cavity, and the need for prompt cesarean delivery and uterine repair or hysterectomy. The risk factors for rupture include previous cesarean sections, multiparity, malpresentation and obstructed labor, uterine anomalies, and use of prostaglandins for induction of labor. Previous cesarean section is, however, the most commonly associated risk factor. The most consistent early indicator of uterine rupture is the onset of a prolonged, persistent, and profound fetal bradycardia.
  
  
  CONCLUSIONS
  In this case series, we suggest that the signs and symptoms of uterine rupture are typically nonspecific, which makes diagnosis difficult. Delay in definitive therapy causes significant fetal morbidity. The inconsistent signs and the short time in prompting definitive treatment of uterine rupture make it a challenging event. For the best outcome, vaginal birth after previous cesarean section needs to be looked after in an appropriately staffed and equipped unit for an immediate cesarean delivery and advanced neonatal support.
authors.affiliation: Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY UK.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Revicky
authors.forename: Aruna
authors.initials: A
authors.lastname: Muralidhar
authors.forename: Sambit
authors.initials: S
authors.lastname: Mukhopadhyay
authors.forename: Tahir
authors.initials: T
authors.lastname: Mahmood
keywords: Previous cesarean section; Prolonged bradycardia; Risk factor; Uterine rupture