title: Uterine Rupture: A Seven Year Review at a Tertiary Care Hospital in New Delhi, India.
abstract: OBJECTIVE
  To identify the obstetric risk factors, incidence, and causes of uterine rupture, management modalities, and the associated maternal and perinatal morbidity and mortality in one of the largest tertiary level women care hospital in Delhi.
  
  
  METHODS
  A 7-year retrospective analysis of 47 cases of uterine rupture was done. The charts of these patients were analyzed and the data regarding demographic characteristics, clinical presentation, risk factors, management, operative findings, maternal and fetal outcomes, and postoperative complications was studied.
  
  
  RESULTS
  The incidence of rupture was one in 1,633 deliveries (0.061%). The vast majority of patients had prior low transverse cesarean section (84.8%). The clinical presentation of the patients with rupture of the unscarred uterus was more dramatic with extensive tears compared to rupture with scarred uterus. The estimated blood loss ranged from 1,200 to 1,500 cc. Hemoperitoneum was identified in 95.7% of the patient and 83% of the patient underwent repair of rent with or without simultaneous tubal ligation. Subtotal hysterectomy was performed in five cases. There were no maternal deaths in our series. However, there were 32 cases of intrauterine fetal demise and five cases of stillbirths.
  
  
  CONCLUSIONS
  Uterine rupture is a major contributor to maternal morbidity and neonatal mortality. Four major easily identifiable risk factors including history of prior cesarean section, grand multiparity, obstructed labor, and fetal malpresentations constitute 90% of cases of uterine rupture. Identification of these high risk women, prompt diagnosis, immediate transfer, and optimal management needs to be overemphasized to avoid adverse fetomaternal complications.
authors.affiliation: Department of Obstetrics and Gynecology, Kasturba Hospital, New Delhi, India.
authors.forename: Maruti
authors.initials: M
authors.lastname: Sinha
authors.affiliation: Department of Obstetrics and Gynecology, West Virginia University - Charleston Division, Charleston, West Virginia, USA.
authors.forename: Ridhima
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Radiology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
authors.forename: Pushpender
authors.initials: P
authors.lastname: Gupta
authors.affiliation: Department of Obstetrics and Gynecology, Kasturba Hospital, New Delhi, India.
authors.forename: Rekha
authors.initials: R
authors.lastname: Rani
authors.affiliation: Department of Obstetrics and Gynecology, Kasturba Hospital, New Delhi, India.
authors.forename: Ramanjeet
authors.initials: R
authors.lastname: Kaur
authors.affiliation: Intern, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Rahil
authors.initials: R
authors.lastname: Singh
keywords: Cesarean section; hysterectomy; obstructed labor; perinatal outcome; rupture of gravid uterus; uterine rupture