The survival of patients after uterine rupture depends on the time interval between rupture and intervention, and the availability of blood products for transfusion. Please enable it to take advantage of the complete set of features! 22, no. Participants were randomly assigned to weekly membrane sweeping or weekly vaginal assessment for Bishop score until delivery. doi:10.1016/0020-7292(94)90405-7. In the five years survey, there were 72000 deliveries without uterine rupture (control) and 194 cases in Adwa General Hospital (, ), Ayder Referral Hospital (, ), Suhul Shire General Hospital (, ), Lemlem Karl Hospital (, ), and Adigrat General Hospital (, ). In the particular case of Mezam Division, Cameroon, the leading causes are Postpartum Hemorrhage (30.43%), unsafe abortion (26.09%), and pregnancy-induced hypertension (14.49%) [1, 2]. Among patients in the reproductive age who have not completed their desired family size, such a procedure could be unacceptable. Google Scholar. In a systematic review by Justus Hofmeyr et al., uterine rupture was reported to be lower in a community-based study (median 0.053%, range 0.016-0.030%) compared to facility-based study (0.031, 0.012-2.9%). After surgery, additional blood, and fluid replacement is continued along with antibiotic theory. Mothers referred from remote health institutions (AOR 7.29 (95% CI: 2.7, 19.68)), mothers who visited once for antenatal care (AOR 2.85 (95% CI: 1.02, 7.94)), those experiencing obstructed labor (AOR 13.33 (95% CI: 4.23, 42.05)), and birth weight of a newborn greater than four kilograms (AOR 5.68 (95% CI: 1.39, 23.2)) were significantly associated with uterine rupture. Int J Trop Dis Health. Malpresentation was recorded in 12.4% (59/475). 2022 BioMed Central Ltd unless otherwise stated. Among those who had uterine rupture, 48 (11.9%) of the mothers received blood transfusions. Studies from Sihul Shire (Ethiopia), Mizan Tepi (Ethiopia), and rural Uganda revealed that obstructed labor was a significant risk factor for uterine rupture [2, 5, 17]. 3, no. Further prospective studies are needed to identify predictors of uterine rupture and predictors with untoward management outcomes. This occurs when the uterus undergoes more strain than it is capable of sustaining during contractions and pregnancy. Epub 2019 Aug 19. Labor and delivery should be supervised by trained health care provider, enabling timely and early detection of prolonged labor by partograph; early identification of fetal macrosomia during antenatal or early labor by ultrasound or other clinical methods of predicting fetal weight should be recommended. 279283, 2006. Would you like email updates of new search results? She owed her life to her timely action. What is a Uterine Rupture Uterine rupture is defined as a full-thickness separation of the uterine wall. A rupture may be discovered during a haemorrhage: uterine exploration after delivery of the placenta reveals the rupture. Conservative management of infected postpartum uterine dehiscence after cesarean section. Passcode Required The content you are trying to view is protected by a passcode. R. Strand, P. Tumba, J. Niekowal, and S. Bergstrm, Audit of cases with uterine rupture: a process indicator of quality of obstetric care in Angola, African Journal of Reproductive Health, vol. Uterine rupture is a disruption of the uterine wall during pregnancy or childbirth. is probably the best way to measure LUS thickness: In a study conducted by Gotoh et al.35 , it was found that transabdominal ultrasound can detect scar defects located there may be incomplete uterine rupture at . treatment guidelines for the management of uterine inversion are based on the best available evidence from case reports, small retrospective case series describing effective treatment options, and expert opinion. Epub 2021 Nov 25. doi:10.1053/j.semperi.2011.05.008. in a previous. Maternal death, stillbirth, hysterectomy, and hemorrhage were adverse outcomes. In the particular case of Mezam Division, Cameroon, the leading causes are Postpartum Hemorrhage (30.43%), unsafe abortion (26.09%), and pregnancy-induced hypertension (14.49%) . Total abdominal hysterectomy was done in 47 (34.8%) of the women, subtotal hysterectomy in 28 (20.74%), uterine repair with bilateral tubal ligation (BTL) in 26 (19.25%), and uterine repair without BTL in 34 (25.2%). Open J Obstet Gynecol. Official cooperation letter was written from Tigray Regional Health Bureau to eastern zone woreda health office then to selected kebelles before data collection was started. factor for uterine rupture, and this is similar to the findings of reported research (19). Among those who had uterine rupture, 48 (11.9%) of the mothers had received blood transfusion. The odds ratio was with their 95% confidence interval; two-tailed value was computed to declare the level of significance. We would like also to thank the data collectors and administrators of the hospitals for their unreserved cooperation and commitment. Uterine rupture and maternal death from hemorrhage is a preventable complication of childbirth in sub-Saharan Africa. A. Pinton, E. Boudier, A. Joal et al., Risk factors and clinical presentation of uterine rupture in the unscarred uterus: a case control study, Journal of Pregnancy and Child Health, vol. Dystocia associated with oxytocin and/or traditional medicines labor augmentation has been observed in 12.6% of cases (60/475). Clinicians must remain vigilant for signs and symptoms of uterine rupture. Berghella V, Airoldi J, O'Neill AM, Einhorn K, Hoffman M. BJOG. . 5562, 2010. Ltd., Swathi Bhat, International Journal of Reproduction, Contraception, Obstetrics and Gynecology, Indonesian Journal of Obstetrics and Gynecology, Gynecology and Obstetrics Research - Open Journal, International Journal of Maternal and Child Health and AIDS (IJMA), Journal of South Asian Federation of Obstetrics and Gynaecology, The role of maternal body mass index in outcomes of vaginal births after cesarean, Serial Membrane Sweeping at Term in Planned Vaginal Birth After Cesarean: A Randomized Controlled Trial. You can download the paper by clicking the button above. 2022 Oct 6;15:551-556. doi: 10.2147/IMCRJ.S383195. doi: 10.1016/j.crwh.2018.e00066. Therefore, labor induction using a trans-cervical Foley catheter was not associated with an increased risk of uterine rupture [19]. Preventing Uterine Rupture Unfortunately, a ruptured uterus cannot be completely prevented. PubMed Background: 3, pp. Epub 2016 May 24. We aim to assess the influence of known antenatal and intrapartum factors on the likelihood of vaginal birth in Indian patients attempting trial of vaginal birth after one previous cesarean section. Mifepristone Followed by Misoprostol or Ethacridine Lactate and Oxytocin for Second Trimester Abortion: A Randomized Trial. Labor and delivery distributions of cases and controls who gave birth at public hospitals of Tigrai, North Ethiopia. AbstractBackground Maternal morbidity and mortality has been a major World Health Organization concern over the years, especially in sub-Saharan Africa. With respect to the rupture location, 47 (34.8%) were anterior, 53 (39.25%) posterior, and 35 (25.92%) lateral. The dataset(s) supporting the conclusions of this article could be obtained from the authors on request by the editors. Use for phrases Introduction - Uterine Rupture Definition Uterine rupture is full-thickness loss of integrity of the uterine wall and visceral peritoneum. It was then concluded that the strongest association of ruptured uterus was with previous scarred uterus, multiparity and<18months duration from the last cesarean section [26]. 1994;46(3):259373. Although risk factors of uterine rupture are context specific, there is lack of clarity in our context towards the contributing factors and untoward outcomes of uterine rupture. Diagnosis is by ultrasonographic measurement of amniotic fluid volume. CAS Outcome of uterine rupture and associated factors in . Among those who had uterine rupture, 101 (74.8%) of their newborns were stillborn (Table 5). Use OR to account for alternate terms Management is by treating read more , or fetal anomalies), Failure to recognize labor dystocia with excessive uterine contractions against a lower uterine restriction ring. It is a rare problem that can happen when giving birth. Horse owners and managers can help by assisting with dystocia or quickly seeking veterinary help, especially in older mares. GEHE, CNT and EBP took part in the management of the patient. This patient presented a 2500 mL hemoperitoneum. Charts (case notes) of women without uterine rupture (control) found after the cases (since cases and controls should be comparable regardless of the presence of the disease of interest, we enrolled controls who were admitted following the cases to avoid seasonal impact on transportation from rural areas and other parameters) were selected randomly and enrolled. Upper-segment caesarean section scar has a higher risk of uterine rupture compared with lower-segment caesarean section (LSCS) scar. Uterine rupture. 4, pp. 3, 2017. Among cases, it was found that 29 (21.5%) of newborn birth weights were four kilograms as opposed to 18 (6.7%) in the control group (Table 3). 2016;15:115. Reports from the study in Mali show that uterine rupture occurred in 87.4% (415/475) of cases in an unscarred uterus vs 12.6% (60/475) in a scarred uterus. The uterine rupture was a dependent variable. Prual et al. Health personnel are almost forgetting the good practice of using the partogram for labor follow-up. Authorization was obtained from the Director of the Douala General Hospital and Consent was obtained from the patient to report the case. Learn more about the MSD Manuals and our commitment to, Abnormalities and Complications of Labor and Delivery. The goodness of fit of the model was checked by the Hosmer-Lemeshow test. Copyright 2022 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. Studies have reported that the incidence rate of uterine rupture in women who attempt VBAC was 9.8 per 1000 and prior vaginal delivery was associated with a lower risk of uterine rupture (adjusted odds ratio [OR] 0.40, 95% CI 0.200.81) [14]. WOMAN HEALTH; . Uterine inversion is a rare but serious complication during childbirth where your uterus turns partially or entirely inside out. American Journal of Obstetrics and Gynecology. M. Kaczmarczyk, P. Sparn, P. Terry, and S. Cnattingius, Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population-based study of successive pregnancies in Sweden, BJOG: An International Journal of Obstetrics & Gynaecology, vol. The data were entered into Epi data Version 3.5.1 and exported to the Statistical Package for the Social Sciences (SPSS) Version 20 software for further analysis. Please enter the related passcode in order to view this content: Invalid passcode Submit To attain this objective, use of misoprostol in primary health facilities should be stopped or proper management of the medication instituted. CNT: Consultant Obstetrician and Gynecologist and Senior Lecturer, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon JEN: Head Nurse operating theatre, Douala General Hospital EBP: Professor of Obstetrics and Gynecology, University of Yaounde 1, Cameroon. Laparoscopic Management of Uterine Rupture After Early Second-Trimester Medical Abortion in a Patient With a Prior Cesarean Section. A. Turgut, A. Ozler, M. S. Evsen et al., Uterine rupture revisited: predisposing factors, clinical features, management and outcomes from a tertiary care center in Turkey, Pakistan Journal of Medical Sciences, vol. PubMed Central Stamilio DM, DeFranco E, Par E, Odibo AO, Peipert JF, Allsworth JE, Stevens E, Macones GA. Short interpregnancy interval: risk of uterine rupture and complications of vaginal birth after cesarean delivery. Mrs. MM aged 25 years, G3P2012, of the Bamileke tribe in Cameroon was admitted to our Department in hypovolemic shock BP = 70/40 mmHg, pulse 120 beats per minute, with altered consciousness (Glasgow Coma Scale = 13). 17, 2013. MEDICAL MANAGEMENT:Immediate stabilization of maternal hemodynamics and immediate caesarean delivery Oxytocin is given to contract the uterus and the replacement .After surgery, additional blood, and fluid replacement is continued along with antibiotic theory. We have used 5% contingency for the incomplete and missed patients cards, while our final complete records for both cases and controls were 405. Trop Doct. 2009;116:106980. Lancet. 1988;332:127780. Namazov A, Grin L, Volodarsky M, Anteby E, Gemer O. J Minim Invasive Gynecol. 80% of the cases were referred. The plaintiff s lawyer claimed that the defendants did not appropriately monitor the plaintiff after the insertion of the dinoprostone and negligently prescribed dinoprostone, misoprostil, and oxytocin to induce labor. Referral to a bereavement counselor, peer support group, or mental health professional may be advisable for management of grief and depression. Int J Trop Dis Health. Fetal condition contraindicating expectant management including chorioamnionitis, placental abruption, intrauterine fetal demise, non-reassuring fetal heart rate at the time of randomization; Cervical dilation > 5 cm; Iatrogenic rupture caused by amniocentesis or trophoblast biopsy; Major fetal anomaly All these factors have thus not been collectively included in various screening tools. PubMed in Burkina Faso reported 46.6% partogram use [17] while Ogwang et al. Cite this article. Majority of the scoring systems have used indication of previous cesarean, Bishops score and history of VBAC in their screening tools. 4, pp. Unable to load your collection due to an error, Unable to load your delegates due to an error, Posterior uterine rupture extending from the fundus to the isthmus and affecting the left broad ligament and uterine vessels (See. I. Al-Zirqi, A. K. Daltveit, L. Forsn, B. Stray-Pedersen, and S. Vangen, Risk factors for complete uterine rupture, Obstetric Anesthesia Digest, vol. This topic will review clinical findings, risk factors, prediction, and management of uterine rupture in patients attempting TOLAC. A tear in the uterus is a serious condition that can lead to numerous complications, including urologic injury, amniotic-fluid embolism (AFE), the need for a blood transfusion, hysterectomy, maternal death, and perinatal problems including neurological impairment or death of the baby. This type of practice should be discouraged because it is associated with obstetric and neonatal complications such as uterine rupture [15]. 2, pp. Its magnitude is greater in Asia and Africa than in high-income countries [3]. In the developing world, uterine rupture can have devastating maternal and/or fetal outcomes due to delayed recognition and/or intervention. -. 2011;35(5):25761. Uterine rupture is a. pregnancy. Summary This chapter discusses the implications, diagnostic signs and management strategies for uterine rupture. Egbe T, Dingana T, Halle-Ekane G, Atashili J, Nasah B. Determinants of maternal mortality in Mezam division in the north west region of Cameroon: a community-based case control study. Management of uterine rupture: a case report and review of the literature, https://doi.org/10.1186/s13104-016-2295-9, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. To attain this objective, use of misoprostol in primary health facilities should be stopped or proper management of the medication instituted. To address this, uterine resection of localized disease has . B. Lindtjrn, D. Mitiku, Z. Zidda, and Y. Yaya, Reducing maternal deaths in Ethiopia: results of an intervention programme in southwest Ethiopia, PLoS One, vol. 4, p. 222, 2016. The survival of patients after uterine rupture. Cases of gestational trophoblastic neoplasia (GTN) with uterine rupture are often catastrophic owing to profuse bleeding, which could be potentially lethal. The proportion of mothers who did not engage in antenatal care in the cases and controls was 22 (16.3%) and 13 (4.8%), respectively. Health Sci Dis. SURGICAL MANAGEMENT: Caesarean Section Laparotomy Hysterectomy There were 14 incomplete cards (missing essential variables and discarded (tear cards)), and 6 case notes (patient cards) were lost. 2010;117:160815. Bujold E, Bujold C, Hamilton EF, Harel F, Gauthier RJ. Marret H, Simon E, Beucher G, Dreyfus M, Gaudineau A, Vayssire C, Lesavre M, Pluchon M, Winer N, Fernandez H, Aubert J. Overview and expert assessment of off-label use of misoprostol in obstetrics and gynaecology: review and report by the Collge national des gyncologues obsttriciens franais. 3.3.3 Management See also algorithm. BJOG Int J Obstet Gynaecol. 112, no. CAS Academia.edu no longer supports Internet Explorer. Google Scholar. Traumatic uterine rupture may result from blunt abdominal traumas such as those that occur during motor vehicle accidents. On examination, the conjunctivae were pale and the pulse rate 120 beats per minute. A Rare Type of Uterine Rupture Following Over-the-Counter Use of Misoprostol in Second Trimester Abortion. complication that is life-threatening for the mother and the baby. Learn more about the MSD Manuals and our commitment to Global Medical Knowledge. Y. Berhan and A. Berhan, Causes of maternal mortality in Ethiopia: a significant decline in abortion related death, Ethiopian journal of health sciences, vol. I. S. J. Dhaifalah and H. Fingerova, Uterine rupture during pregnancy and delivery among women attending the Al-Tthawra Hospital in Sanaa City Yemen Republic, Biomedical Papers, vol. While there is increased maternal and perinatal morbidity associated with the failure of trial of vaginal birth after cesarean section (VBAC), a successful trial of VBAC reduces the risk of complications in future pregnancies, associated with a repeat cesarean section. PubMedGoogle Scholar. 2015;187:804. Zwart J, Richters J, ry F, de Vries J, Bloemenkamp K, van Roosmalen J. Keyword : Uterine rupture, Primigravid, Unscarred . https://doi.org/10.1186/s13104-016-2295-9, DOI: https://doi.org/10.1186/s13104-016-2295-9. Depending on the nature of the rupture and the condition of the patient, the uterus may be either repaired or removed (cesarean hysterectomy). Ethiop J Health Dev. There were 72000 live births in the study area with 194 cases of uterine rupture in five years data extraction from case notes of mothers. Full PDF Package Download Full PDF Package. T. L. Dadi and T. E. Yarinbab, Estimates of uterine rupture bad outcomes using propensity score and determinants of uterine rupture in Mizan-Tepi University teaching hospital: case control study, Journal of pregnancy, vol. BMC Res Notes 9, 492 (2016). Indian patients have not had a large representation in former studies. Uterine rupture was defined as tearing of the uterine wall either partially or complete during pregnancy and labor, diagnosed either clinically and later confirmed at laparotomy. Maternal and fetal outcomes that develop uterine rupture among mothers who gave birth at public hospitals of Tigrai, North Ethiopia. A retrospective study. An ovarian cyst is a fluid-filled sac that forms on or inside an ovary. Google Scholar. Screening tools consider the relative effect of multiple factors to predict an individuals likelihood of vaginal delivery [3]. management immediate delivery in most cases, total abdominal hysterectomy is the . Health care providers should encourage mothers to complete the recommended four visits as these contribute to full risk assessment and screening opportunities for the mom and the fetus. 37, no. government site. 6, no. 161202. However, blood transfusions were very common in studies done in Debre Markos (78%) and Pakistan (83%) [4, 21]. After calculating the previous five years admission of mothers in obstetric ward and knowing the total case load in each selected hospital, the sample size was allocated to the hospitals proportionally. Am J Obstet Gynecol. Bookshelf Uterine rupture is spontaneous tearing of the uterus that may result in the fetus being expelled into the peritoneal cavity. 2004;103:1823. Accessibility Treatment of uterine rupture is immediate laparotomy with cesarean delivery and, if necessary, hysterectomy. Secondary outcomes included induction of labor and repeat cesarean delivery. Rupture was defined as full thickness uterine wall defect with bleeding necessitating operative intervention. The final sample size was 135 cases and 270 controls. Am J Obstet Gynecol. The findings of this study suggest early identification of factors that expose to uterine rupture during antenatal care, labor, and delivery must be attended to and further prospective studies are needed to explore predictors of untoward outcomes. INTECH Open Access; 2012. pp. 2018 May 30;19:e00066. . 2002;16:2415. sharing sensitive information, make sure youre on a federal Part of Some have used other factors like maternal age, weight, inter-delivery period, estimated fetal weight and history of term/preterm cesarean section [4]. We have used an unmatched case control study for frequency and ensured that cases and controls are not identical; however, they are comparable and share the same geographical and social backgrounds. official website and that any information you provide is encrypted The uterine layers are: The first layer is the endometrium (inner epithelial layer). Maternal mortality, one of the major concerns of the World Health Organization, remains high in most of sub-Saharan Africa . Definition Uterine rupture is a tear in the muscle of the uterus (womb). Bivariate and multivariate logistic regression with 95% confidence interval was used to identify the determinants of uterine rupture. As soon as doctors even suspect uterine rupture, they must immediately . The trusted provider of medical information since 1899, Introduction to Abnormalities and Complications of Labor and Delivery, Medically Reviewed Jul 2021 | Modified Sep 2022. Out of 135 mothers who develop uterine rupture, intraoperative findings found that 75 (55.5%) had a complete uterine rupture. This study is aimed at addressing determinant factors of uterine rupture and its adverse maternal and fetal management outcomes in public hospitals of Tigrai. Several studies have shown that the shorter the time between a cesarean delivery and a subsequent delivery, the higher the rate of uterine rupture. Tayade S, Chadha A, Khandelwal S, Makhija N, Tilva H, Madaan S. Cureus. Five (3.7%) of the cases and 12 (4.4%) of the controls were instrument deliveries. Terms and Conditions, For example, during rainy seasons, women in rural areas do not come to seek obstetric care at a higher facility due to the unavailability of transportation. Management often entails removal of the uterus. Maternal death, stillbirth, hysterectomy, and excessive blood loss were adverse outcomes of uterine rupture. Introduction. MeSH terms Adult Blood Transfusion Female Fetal Death / etiology Fluid Therapy Humans Incidence Obstetric Labor Complications / epidemiology* Obstetric Labor Complications / therapy* Pregnancy Stillbirth Uterine Rupture / diagnosis Most uterine ruptures in resource-rich countries are associated with a trial of labor after cesarean birth (TOLAC). Wacker et al. Maternal and perinatal complications with uterine rupture in 142,075 patients who attempted vaginal birth after cesarean delivery: A review of the literature, Prevention and Management of Postpartum Hemorrhage: A Comparison of Four National Guidelines, Adverse Obstetric Outcomes in Women with Previous Cesarean for Dystocia in Second Stage of Labor, Uterine rupture: differences between a scarred and an unscarred uterus, Safety of late second-trimester pregnancy termination by laminaria dilatation and evacuation in patients with previous multiple cesarean sections, Trial of labor and vaginal birth after cesarean section in patients with uterine Mllerian anomalies: a population-based study, Uterine rupture in Mekelle, northern Ethiopia, between 2009 and 2013, Cervical Ripening with Low-Dose Prostaglandins in Planned Vaginal Birth after Cesarean, Modified Bishop's score and induction of labor in patients with a previous cesarean delivery, Risk of uterine rupture in women undergoing trial of labour with a history of both a caesarean section and a vaginal delivery, Serial Membrane Sweeping at Term in Planned Vaginal Birth After Cesarean, Advances in the treatment of postpartum hemorrhage, Uterine rupture in pregnancy: two case reports and review of literature, Toolkit to Support Vaginal Birth and Reduce Primary Cesareans A Quality Improvement Toolkit, Cervical ripening with Foley catheter for induction of labor after cesarean section: a cohort study. uterine rupture complete transection of the uterus from the endometrium to the serosa partial or complete prior scar - 40%; unscarred - 60% warning signs sharp abdominal pain, foetal distress, unable to palpate presenting part vaginally, maternal shock, abnormal contouring of abdomen. Uterine rupture in the Douala General Hospital, Cameroon: prevalence, risk factors, management and prognosis. Adjusted odds ratios range from 2.5 to 3 for an increased rate of uterine rupture in the women with less time between deliveries. Berhe Y, Gidey H, Wall LL. Many patients in developing countries present for the first time in their pregnancy when in labor. This may be due to delays in reaching health facilities due to long distances and poor road networks; many mothers end up with uterine rupture. If the fetus has been expelled from the uterus and is located within the peritoneal cavity, fetal and maternal morbidity and mortality increase significantly. Ekane GEH, Obinchemti TE, Tchente CN, Fokunang LK, Njamen TN, Bechem NN, Njie MM, Latum D. Attainment of the fifth millennium development goal: utopia or reality based on trends in maternal mortality in 12 years in two regional hospitals in fako division, Cameroon? You may need to take pain medicine. o [teenager OR adolescent ]. For 127 (94.1%) of the cases and 269 (99.6%) of the controls, delivery was at one of the hospitals. In Ethiopia, the prevalence of uterine rupture ranges from 1.244% to 9.5% [4, 7, 8]. We carried out a total abdominal hysterectomy and peritoneal toileting. Wacker J, Utz B, Kyelem D, Lankoande J, Bastert G. Introduction of a simplified round partogram in rural maternity units: seno province, Burkina Faso, West-Africa. This may have been the appropriate method for our patient although she was at no particular risk of uterine rupture. 2005 Sep-Oct;20(5):469-71. doi: 10.1159/000087115. Controls were women who had spontaneous vaginal delivery or who delivered by caesarean section without uterine rupture as a complication. BMC Research Notes, 2016. Commonly, thresholds of 18 and 24months have been examined. Obstet Gynecol. It is a potentially life threatening condition for both the mother and/or the baby and requires immediate surgical intervention. The study by Nguefack et al. Springer; 2014. pp. Am J Obstet Gynecol. Despite strengthening the health care system and provision of basic and comprehensive emergency obstetric care, Ethiopian women continue to face devastating maternal and fetal outcomes, particularly in the study area [14]. CONCLUSION: Serial membrane sweeping at term in women who planned VBAC has no significant effect on the onset of labor, pregnancy duration, induction of labor, or repeat cesarean delivery. Hussein AI, Omar AA, Hassan HA, Kassim MM, Yusuf AA, Osman AA. Uterine Rupture Following Non-Operative Vaginal Delivery: A Close Save of Delayed Presentation With Hemoperitoneum to a Rural Tertiary Care Hospital. doi: 10.1016/j.ejogrb.2015.01.018. The link you have selected will take you to a third-party website. 2010;115:10036. From 135 mothers who develop uterine rupture, 13 (9.6%) mothers died and 101 (74.8%) fetuses were stillborn. Am J Obstet Gynecol. During surgery, we found that there was hemoperitoneum estimated at about 2500mL and the uterus was completely torn posteriorly from the fundus to the isthmus and extending to the left broad ligament with involvement of the ascending branch of the uterine artery (Figs. 2007;110:107582. Springer Nature. Eur J Obstet Gynecol Reprod Biol. in a case fatality study of maternal morbidity from 23 West African countries and 20326 pregnant women between 32 and 36weeks amenorrhea during delivery and up to 60days post partum reported that uterine rupture accounted for 0.12 per 100 live births [8]. Management and Complications of Uterine Rupture at Mizan-Tepi University Teaching Hospital, Mizan-Aman Town, Bench-Maji Zone, Snnprs, South West Ethiopia, 2016/17 . 2022 Jan 10;14(1):e21076. Although much attention is paid to scar rupture associated with uterotonic agents, 13% of ruptures occurred in unscarred uteri and 72% occurred during spontaneous labour [27]. Similar to this study, referred mothers from remote health institutions were associated with uterine rupture in Arbaminch (Southern Ethiopia), Mbarara, Uganda, and Debre Markos, Ethiopia [7, 13, 16]. Adanu RMK, McCarthy MY. Uterine rupture is a life-threatening pregnancy complication for both the mother and fetus. Bujold E, Mehta SH, Bujold C, Gauthier RJ. Vaginal birth after cesarean delivery in the West African setting. Our patient was not at particular risk for uterine rupture. The mass was dissected and hemostasis was secured using sutures and electrocoagulation. Assessment of individual risks and the likelihood of VBAC can help determine appropriate candidates for trial of labor. G. J. S. L. Hofmeyr, L. Say, and A. M. Guilmezoglu, SYSTEMATIC REVIEW: WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture, BJOG, vol. HHS Vulnerability Disclosure, Help o [ pediatric abdominal pain ] doi: 10.5005/jp-journals-10071-24013. Labour outcome of pregnancies with previous lower segment Cesarean section, The ethics of vaginal birth after cesarean, Rupture of Unscarred Pregnant Uterus: A Catastrophic Event: Case series and Review of Literature, Cesarean delivery technique among HIV positive women with sub-optimal antenatal care uptake at the Douala General Hospital, Cameroon: case series report, Fetomaternal Outcome in Post Caesarean Pregnancy, A Study of maternal outcome in uterine rupture in pregnancy at a Tertiary Care Institute, Incidence and factors associated with outcomes of uterine rupture among women delivered at Felegehiwot referral hospital, Bahir Dar, Ethiopia: cross sectional study, MEchanical DIlatation of the Cervix in a Scarred uterus (MEDICS): the study protocol of a randomised controlled trial comparing a single cervical catheter balloon and prostaglandin PGE2 for cervical ripening and labour induction following caesarean delivery, Maternal and neonatal outcome in pregnancy with previous lower segment caesarean section undergoing trial of scar. These training institutions are unregulated and do not follow a standard [15]. Int J Gynecol Obstet. A short summary of this paper. If the mothers card (case note) missed dependent and other significant variables under study, then it will be excluded from the study; missed and tear cards were excluded. Uterine rupture is rare. Five data collectors with a Bachelor of Science in Midwifery degree were recruited. We do not control or have responsibility for the content of any third-party site. ; Contact Us Have a question, idea, or some feedback? Other predisposing factors include congenital uterine abnormalities, trauma, and other uterine surgical procedures such as myomectomies or open maternal-fetal surgery. Bivariate and multivariable logistic regression analysis result of significant variables (. Risk of uterine rupture associated with an interdelivery interval between 18 and 24 months. When physicians use labor-enhancing drugs, they must carefully monitor the fetus for signs of distress and be prepared to promptly respond if tachysystole occurs. This paper reports uterine rupture with severe hypovolemic shock managed at the Douala General Hospital, Cameroon. For patients with 3 prior cesarean births, classical cesarean birth, 31 percent of repeat cesarean births were performed via a classical hysterotomy . . 2006;195:11437. Van der Walt WA, Cronj HS, Bam RH. Sample size was calculated using Epi-info Version 7 based on the following assumptions: 95% level of confidence, 80% power, taking two to one ratio of controls to case (2:1). A A uterine rupture typically occurs during labor, but can also occur during antenatal period. This finding is consistent with studies done in Yirgalem (Southern Ethiopia), Debre Markos (Ethiopia), Mizan Tepi, Uganda, Nigeria, and Yemen [4, 5, 15, 17, 22, 23]. Uterine Rupture Guideline for Management Trust ref:C45/2011 1. Int J Gynecol Obstet. All the authors proofread the final manuscript. To attain this objective, use of misoprostol in primary health facilities should be stopped or proper management of the medication instituted. Although the magnitude is relatively low, it accounts for 18.8% to 36% of maternal mortality [9] and more than 35% of registered maternal deaths were due to uterine rupture [4]. Uterine prolapse is a relatively uncommon complication of parturition, occurring infrequently in cats and rarely in dogs. This site complies with the HONcode standard for trustworthy health information: verify here. Careers. Graham D, Agrawal N, Roth S. Prevention of NSAID-induced gastric ulcer with misoprostol: multicentre, double-blind, placebo-controlled trial. The possible explanation could be the differences in health care providers skills, severity of cases, time for securing hemostasis, the need for fertility and individualized decision-making, and protocols. . Keywords: Prompt diagnosis is necessary to treat this complication given its quick onset and progression, and prevent potential life-threatening complications to mother and fetus. Chart number of women diagnosed with uterine rupture who met the criteria was enrolled consecutively. 151155, 2015. 2011;61:399401. Thomas Obinchemti Egbe. Uterine rupture is a complication that can be eliminated under conditions of best obstetric practice. Bethesda, MD 20894, Web Policies Uterine rupture is a complication that can be eliminated under conditions of best obstetric practice and use of misoprostol in primary health facilities should be stopped or proper management of the medication instituted. DA, NE, WM, SG, BG, MG, FT, HD, HT, HG, and YH contributed to data analysis and interpretation and drafted the manuscript. Therefore, those who have once visited antenatal care may be overlooked in the identification of risk factors contributing to obstructed labor or delaying access to care alternatives (such as caesarian section). 114, no. 2002;16:6979. Egbe et al. She remained at the Department of Obstetrics and Gynecology for 5 more days and her hemoglobin level on discharge was 8.1g/dL. One hundred and eight (80%) and 67 (24.8%) of the mothers were referred from remote health facilities aligned with cases and controls, respectively (Table 1). Macones George A, Peipert Jeffrey, Nelson Deborah B, Odibo Anthony, Stevens Erika J, Stamilio David M, Pare Emmanuelle, Elovitz Michal, Sciscione Anthony, Sammel Mary D, Ratcliffe Sarah J. Maternal complications with vaginal birth after cesarean delivery: a multicenter study. 2005;112:12218. For those who visited antenatal care, 49 (43.8%) of the cases and 170 (64.45%) of the controls had four or more visits. Knowing the risk factors of uterine rupture will potentially assist women, providers, and health systems to take actions on each factor to decrease maternal as well as perinatal morbidity and mortality related to uterine rupture. Without treatment, an inverted uterus can lead to severe blood loss, shock and even death. The primary outcome was onset of labor which was defined as the presence of spontaneous regular and painful contractions that cause cervical dilation to at least 3 cm or prelabor rupture of membranes. 2014;4:771781. Ekane GEH, Obinchemti TE, Tchente CN, Fokunang LK, Njamen TN, Bechem NN, Njie MM, Latum D. Attainment of the fifth millennium development goal: utopia or reality based on trends in maternal mortality in 12 years in two regional hospitals in fako division, Cameroon? Ethical approval was obtained from a research and ethical approval committee of the College of Health Sciences of Adigrat University with a code number AGU/CMHS/084/11. Bujold E, Blackwell SC, Gauthier RJ. Uterine repair without tubal ligation leaves a uterus that is more prone to repeat rupture while uterine repair with bilateral tubal ligation (BTL) or (sub)total hysterectomy predispose survivors to psychosocial problems like marital disharmony. With the advent of misoprostol, a prostaglandin E1 analog is cheap and accessible to most health facilities in Cameroon and most countries in sub-Saharan Africa. In bivariate logistic regression, 20 variables showed association with uterine rupture at value of <0.2. Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, Fat DM, Boerma T, Temmerman M, Mathers C, Say L. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. o [ abdominal pain pediatric ] 12, no. The abdomen was distended and tender on palpation. Purpose Stillbirth is one of the most common adverse pregnancy outcomes, occurring in 1 in 160 deliveries in the United States. The reasons for this may be lack of capacity to recognize and manage abnormal pattern of labor at district, primary hospitals and health centers; despite the governments health policy that envisioned decentralizing emergency and comprehensive obstetric services to the community, still many women referred to referral and tertiary hospitals. This study was conducted in selected public hospitals in Tigrai. Uterine rupture is a clinical diagnosis and there must be a high index of suspicion by the healthcare provider. The documented immediate causes of maternal deaths were hypovolemic shock [8], septic shock [2], and other causes like pulmonary edema [1] and acute renal failure [1]. Mrs. MM aged 25years, G3P2012, of the Bamileke tribe in Cameroon was admitted to our Department in hypovolemic shock BP=70/40mmHg, pulse 120 beats per minute with altered consciousness (Glasgow Coma Score=13). The median age of the women in cases and controls was 30 () and 26 (), respectively. The authors declare that they have no competing interests. Uterine overdistention (due to multifetal pregnancy Multifetal Pregnancy Multifetal pregnancy is presence of > 1 fetus in the uterus. Uterine rupture during second trimester abortion with misoprostol. It has been recently used in the treatment of post-partum hemorrhage and complications of abortion [4]. MB was the principal investigator who contributed to the conception and design of the study; collected, entered, analyzed, and interpreted the data; prepared the manuscript; and acted as a corresponding author. Studies in Bangladesh and India report the use of oxytocin by unqualified allopathic practitioners (UAP) providing health services to the poor [15]. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Uterine perforation at the time of vacuum aspiration is a rare but potentially serious complication, estimated to occur in between 0.1-3 per 1,000 induced abortion procedures (Kerns & Steinauer, 2013; Pridmore & Chambers, 1999). Finally, health facility, number of antenatal visits, experience of obstructed labor, and birth weight of newborn were found to be statistically associated with uterine rupture. Nguefack et al. 495527. The authors declare that they have no competing interests. Other methods of controlling bleeding during a uterine rupture, after the baby has been delivered, include: Abdominal packing- sponges and towels should be packed into the uterus and abdomen to control bleeding via pressure Uterine artery ligation or internal iliac artery ligation Other methods of hemostasis like flowseal et al. Uterine rupture is spontaneous tearing of the uterus that may result in the fetus being expelled into the peritoneal cavity. Lancet. Maternal mortality, one of the major concerns of the World Health Organization, remains high in most of sub-Saharan Africa [1, 2]. Ruptured uterus-eight year retrospective analysis of causes and management outcome in Adigrat Hospital, Tigray Region, Ethiopia. Classical versus low-segment transverse incision for preterm caesarean section: maternal complications and outcome of subsequent pregnancies. TOE wrote the manuscript, TOE and JEN did the surgical operation. S. A. Alyu and T. B. Lema, Prevalence and associated factors of uterine rupture during labour among women who delivered in Debremarkos hospital, Internal Medicine, vol. Forty (29.6%) of the cases and 35 (13%) of the controls were grand multiparous (5 births). , MD, Children's Hospital of Philadelphia. Request PDF | Management of uterine rupture during molar pregnancy | Gestational trophoblastic disease (GTD) is rare and encompasses several clinicopathologic forms from pre-malignant to malignant . The mothers referred from remote health institutions were 7.29 times more likely to develop uterine rupture compared to those who did not have referrals (AOR 7.29; 95% CI: 2.7, 19.68). Article Bull World Health Org. Ogwang S, Karyabakabo Z, Rutebemberwa E. Assessment of partogram use during labour in rujumbura health Sub district, Rukungiri district, Uganda. In another population-based study in the Netherlands, the incidence of uterine rupture was comparable with other Western countries. Uterine rupture is an obstetric calamity with surgery as its management mainstay. 2021 Nov;21(4):657-659. doi: 10.18295/squmj.4.2021.050. A Case Report and Review of the Literature. BMC Research Notes Please confirm that you are a health care professional. Lancet. 37 Full PDFs related to this paper. Uterine rupture occurs most often along healed scar lines in women who have had prior cesarean deliveries Cesarean Delivery Cesarean delivery is surgical delivery by incision into the uterus. Ultrasound diagnosis of a uterine rupture postdelivery is rarely described in the literature. 7, no. [Uterine rupture during second trimester abortion induced with misoprostol]. It causes a mother's uterus to and the baby slips into her abdomen. The optimal dose for this medication has been a controversial issue and practitioners, especially those with little or no experience with the manipulation of this medication, sometimes have difficulties that could lead to life-threatening consequences like uterine rupture [5]. Int J Gynecol Obstet. Use of the partogram in the Bamenda health district, north-west region, Cameroon: a cross-sectional study. Here, we present 2 cases of non-surgical management of UR following vaginal delivery, which were both treated by uterine transarterial embolization (UAE). Conclusion. An emergency positive culdocentesis was done. One of the greatest concerns regarding VBAC is the potential for uterine rupture. The cases were obtained from the labor and delivery ward, operating theatre registers, and from the patients case files retrospectively. UAPs, comprising village doctors (VDs) and unlicensed drug sellers, have limited training of a few weeks to a few months from semiformal private institutions, focused on common illnesses and diseases, and rarely on labour or delivery. A complete uterine rupture is a tear through the thickness of the uterine wall at the site of a prior cesarean incision. In some cases, the cyst can break open (rupture). This frequency increases with advancing gestational age and when performed by less experienced providers (ACOG, 2019). To attain this objective, use of misoprostol in primary health facilities should be stopped or proper management of the medication instituted. The reason might be failing of detecting fetal macrosomia during antenatal care which contributes to fetal-pelvic disproportion and may lead to prolonged and neglected obstructed labor. Gessessew A, Melese MM. Obstet Gynecol. 1, pp. How is uterine rupture treated? DEFINITION Uterine rupture It is defined as "dissolution in the continuity of uterine wall any time after 28 weeks of gestation, with or without expulsion of the fetus.". However, others suggest a planned cesarean delivery at 38weeks gestation [24]. Variables with a value < 0.2 at the bivariate logistic regression were entered to multivariable logistic regression to identify the independent predictors of uterine rupture, to control the confounding variables, and to produce adjusted odds ratio with their corresponding confidence limits. 5, p. 2, 2016. Management of uterine rupture: a case report and review of the literature. As a result, the rates of uterine rupture have increased noticeably. Z. Such variance may relate to the differences in the hemodynamic state of patients and the availability of blood for transfusion. 2000;78:593602. doi: 10.4236/ojog.2014.413107. Keywords: Uterine rupture, risk factors management, maternal and fetal outcomes. The survival of patients after uterine rupture depends on the time interval between rupture and intervention, and the availability of blood products for transfusion. . volume9, Articlenumber:492 (2016) Bujold E, Gauthier RJ. Management of uterine rupture: a case report and review of the literature. 10, pp. Some of the patients do not have access to optimum antenatal care and they do not have the chance to be timely assessed by a qualified clinician. There is a steady decrease in the rate of vaginal birth after cesarean (VBAC) [11]. Sultan Qaboos Univ Med J. Ethnicity has been shown to influence not only trial of labor (TOL) rates but also rates of VBAC. Another study in Ethiopia reported a prevalence of 0.9% [10]. Uterine rupture is a complication that can be eliminated under conditions of best obstetric practice. CAS Download Download PDF. But your doctor can predict the likelihood of a uterine rupture and take measures to prevent it.. This assertion was added to the abstract concluding session. Provided by the Springer Nature SharedIt content-sharing initiative. Studies in patients attempting VBAC have shown that the highest rate of maternal complications occur in patients who have a failed attempt at VBAC, intermediate in those who have an elective repeat cesarean section and lowest in those who have a successful VBAC[1]. The early and timely referral of cases should be promoted for rural and remote health institutions. An early diagnosis of an interstitial pregnancy diagnosis is extremely important for timely management but challenging because of difficult ultrasound aspects. 2016;387:46274. In conclusion, this study found that referrals from remote health institutions, antenatal care visit once, obstructed labor, and birth weight of newborns were significant determinants of uterine rupture. The odds of developing uterine rupture for women experiencing obstructed labor were 13.33 times higher compared to those who had no experience with obstructed labor (AOR 13.33; 95% CI: 4.23, 42.05). Treatment & Management of Uterine Rupture . With an incomplete rupture, or uterine dehiscence, the uterine serosa (perimetrium) surrounding the uterus remains intact.With a complete rupture, the serosa ruptures along with the myometrium, and the contents of the uterus are released into the peritoneal cavity. -, Syed S, Noreen H, Kahloon LE, Chaudhri R. Uterine rupture associated with the use of intra-vaginal misoprostol during second-trimester pregnancy termination. The spontaneous labor rate was 78.5% compared with 72.1% (relative risk [RR] 1.1, 95% confidence interval [CI] 0.9-1.3; P=.34), the induction of labor rate was 12.1% compared with 9.6% (RR 1.3, 95% Cl 0.6-2.8; P=.66), and the all-cause cesarean delivery rate was 40.2% compared with 44.2% (RR 0.9, 95% Cl 0.7-1.2; P=.58) for the membrane sweeping and control groups, respectively. Finally, uterine rupture is a complication that can be eliminated if best obstetric practice is ensured. D. L. A. Thisted, L. H. Mortensen, and L. Krebs, Uterine rupture without previous caesarean delivery: a population-based cohort study, European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. Obstetrical complications like abdominal hysterectomy in 75 (55.6%) of mothers and excessive blood loss in 84 (57.8%) were additional untoward outcomes of uterine rupture. Causes It happens more often in women who have had prior surgery on their womb, such as a cesarean section (c-section). This unmatched case control study is aimed at identifying the risk factors of uterine rupture and describing maternal and fetal outcomes of uterine rupture. The third is the perimetrium (outer surface). Summary. This Paper. Augustin G. Spontaneous uterine rupture. Among all demographic factors analyzed ethnicity has shown to have a significant impact on the outcome of trail. 9, pp. Cards of mothers, who gave birth from 1/9/2015 to 30/6/2019 in selected public hospitals of Tigrai, were retrieved. in 2016 [ 9 ]. Although a limited number of successful . Egbe O Thomas. This study also showed obstructed labor to be the strongest significant risk factor for uterine rupture. One referral and four general hospitals were selected randomly from all general and referral hospitals found in Tigrai region. 1, pp. Some ruptures can happen from prior . 1500mL of blood was secured from the laboratory and she underwent an emergency laparotomy with a sub-umbilical mid-line incision. There is evidence to suggest that overall success of a VBAC ranges from 72-76 % [2], with factors that can increase or decrease the chances of success. In a systematic review by Justus Hofmeyr et al., uterine rupture was reported to be lower in a community-based study (median 0.053%, range 0.0160.030%) compared to facility-based study (0.031, 0.0122.9%). Google Scholar. Department of Obstetrics and Gynecology, Douala General Hospital, Douala, Cameroon, Thomas Obinchemti Egbe,Gregory Edie Halle-Ekane,Charlotte Nguefack Tchente&Eugene Belley-Priso, Faculty of Health Sciences, University of Buea, Buea, Cameroon, Thomas Obinchemti Egbe&Gregory Edie Halle-Ekane, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon, Operating Theatre, Douala General Hospital, Douala, Cameroon, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaound, Cameroon, You can also search for this author in In line with a study conducted in Debre Markos (Ethiopia), France, and Denmark [4, 18, 19], this finding found that those who had a birth weight of four and above kilograms had high odds of developing uterine rupture. Turner et al. Among women with unscarred uterus, 14 presented with rupture and seven of these women were induced in hospital. Uterine rupture is rare. GEHE: Consultant Obstetrician and Gynecologist and Senior lecturer, Faculty of Health Sciences, University of Buea, Cameroon. The funding organization has no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript; this was the role of the authors. Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images. Halperin ME, Moore DC, Hannah WJ. Conclusion: This can c. 12211228, 2005. We would like to recognize Tigray Regional Health Bureau for the invaluable support. This case stresses the importance of good obstetric practice and the need for qualified medical and paramedical staff. Rupture of a myomectomy site in the third trimester of pregnancy after myomectomy, septoplasty and cesarean section: A case report. reported that uterine rupture in the majority of cases is associated with poor and traumatic obstetric practice [31]. 173-174, 2017. Cookies policy. Uterine rupture is a complication of labour, where the muscle layer of the uterus (myometrium) ruptures. Manage cookies/Do not sell my data we use in the preference centre. After this procedure, a woman can no. She came to our Department relatively early, about 30min after the incident, and we intervened immediately, aided by the fact that compatible blood was available in the blood bank. The cases were obtained from the labor and delivery ward, operating theatre registers, and from the patients' case files retrospectively. PubMed In addition, we have tried to avoid seasonal impact. 12081214, 2007. Usually, destruction to the uterus is not correctable and the outcome is often a hysterectomy [1]. Posterior uterine rupture extending from the fundus to the isthmus and affecting the left broad ligament and uterine vessels (See arrows), Posterior wall uterine rupture extending from the fundus to the isthmus. The possible explanations could be due to the absence of antenatal care follow-up, distances hindering referral and increasing time to care, contribution of delays from family, and delays in health institutions. This study also found maternal death, excessive blood loss, abdominal hysterectomy, and a significant number of stillbirths as untoward outcomes of uterine rupture. To this end, preventive strategies for obstructed labor require a multidisciplinary approach, as the factors are multifactorial. However, uterine ruptures have also been known to occur in some . 14, no. Case presentation: 1988;332:12771280. Our appreciation goes to Adigrat University for the financial support. Risk factors for such ruptures may include previous uterine scar, short birth spacing, and use of uterotonic (oxytocin/prostaglandin) medications [9, 29, 30]. Direct complication of ruptured uterus includes 59.8% to 88.8% which incur severe blood loss; and 14% to 51.8% undergo total abdominal hysterectomy. She has a history of missed abortion at 19 weeks gestation and an attempt to evacuate the uterus with misoprostol that led to uterine rupture. In particular, implantation in the intrauterine portion of the fallopian tube with invasion of uterine wall makes the ultrasound differentiation from an intrauterine pregnancy very . Although all these factors have been shown to influence VBAC trail outcome in some studies , they have not achieved statistical significance in other studies. Most cases of uterine rupture occur during labour following . Introduction and Who Guideline applies to This document sets out the procedures and processes to follow in the event of a uterine rupture with the intention of providing safe and effective care to this patient group. Sociodemographic factors claimed in the literatures to determine uterine rupture were maternal age, occupation, referral status, residence, and pregnancy and labor and delivery-related factors including labor induction, grand multiparity, lack of ANC follow-up, history of previous caesarian section (C/S), prolonged labor, obstructed labor, lack of partograph utilization, and instrumental delivery. Egbe, T.O., Halle-Ekane, G.E., Tchente, C.N. Prual A, Bouvier-Colle M-H, de Bernis L, Breart G. Severe maternal morbidity from direct obstetric causes in West Africa: incidence and case fatality rates. 1, p. 29, 2013. There was a fluid thrill, shifting dullness and mild vaginal bleeding. 6, no. Early clinical diagnosis is paramount to maternal survival. JPMA J Pak Med Assoc. 115, 2013. A scarred uterus is not a necessary pre-condition for uterine rupture. Having a care team that's prepared for emergencies can prevent these outcomes from happening. 3. Participants and delivery providers were blinded to the allocated treatment. Early clinical diagnosis is paramount to maternal survival. Misoprostol for second trimester pregnancy termination in women with prior caesarean: a systematic review. By using this website, you agree to our Article Studies from Sihul Shire, Ethiopia, Mizan Tepi, Ethiopia, and Mbarara, Uganda [2, 13, 17] have shown that uterine rupture is highly related with antenatal care attendance, consistent with the findings of this study. California Privacy Statement, Sorry, preview is currently unavailable. 10, no. low-transverse cesarean births show a trend toward increased risk of rupture compared with a single prior cesarean . 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