Rupture of the gravid uterus: Experience of the Maternity Hospital, Kuwait

Objective: To review the cases of ruptured uteri at the Maternity Hospital, Kuwait, over a period of 11 years, and to analyze the predisposing factors, maternal and fetal outcome and modes of management. Method: This is a retrospective study of 91 cases of uterine rupture out of 168,486 deliveries at the Maternity Hospital, Kuwait, between January 1981 and December 1993. Result: The incidence of uterine rupture was 1 in 1,851. A previous uterine scar was present in 51 (56%) cases. The percentage of cases with instrumental delivery, malpresentation, history of previous cesarean section, use of oxytocics, higher age of the mother and parity of 5 or more was significantly higher in mothers with uterine rupture than mothers without uterine rupture. The percentage of cases with parity of 5 or more a nd those using oxytocics was significantly higher in the unscarred uterus group than scarred uterus group. Anterior lower segment was the most common site of rupture. The percentage of cases with simple repair of the uterus was higher in patients with the unscarred uterus than scarred uterus. Total hysterectomy was more common in patients with previously unscarred uterus. The perinatal and maternal mortality was 25.5 and 3.3%, respectively. Conclusion: The incidence of uterine rupture in this study is comparable to that in developed countries. Previous uterine scar, use of oxytocics, grand multiparity, instrumental delivery and malpresentation are associated with the rupture of the gravid uterus. Copyright (C) 2000 S. Karger AG, Basel.