A 10-year review of ruptured uterus at the University of Nigeria Teaching Hospital disclosed an incidence of 1 in 500 deliveries. The average incidence for booked patients alone was 1 in 1271 deliveries. The maternal and perinatal mortalities were 17% and 91% respectively, while the contributions of ruptured uterus to the overall hospital maternal and perinatal mortalities for the period under review were 4.1 and 2.6% respectively. In 1978, the average incidence of ruptured uterus in all patients delivered at the hospital increased from 1 in 787 in the 1st 5 years to 1 in 330 in the 2nd 5 years, while the maternal mortality from ruptured uterus decreased from 27% in the 1st 1/2 to 10% in the 2nd 1.2 of the study. The decline in maternal mortality in this environment is due to better availability of stored blood and management which included subtotal hysterectomy in many cases.

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Objective: It has been proposed that thickness of chorioamniotic membranes is a predictor of preterm delivery (UOG 2008; 32 : 205). The objective was to evaluate sonographic membrane thickness (MT) throughout gestation in 3 different sites: chorionic plate (CP), uterine free wall (FW), and cervix. Method: A prospective, cross-sectional study was performed in patients with singleton pregnancies who underwent transabdominal and transvaginal US. MT was measured in 3 sites: CP, uterine FW (area free of placenta), and cervix (at or within 2 cm of internal os). Three measurements were taken per site. Exclusion criteria were: short cervical length (< 2.5 cm), funneling, positive response to transfundal pressure, presence of sludge, vaginal infections, medical complications, and fetal anomalies. Data analysis was done using linear regression. P<0.05 was considered significant. Intra-observer variability was assessed by 1 operator in 10 patients (for each of the 3 sites), and % coefficient of variation (CV) was computed. Result: MT could be measured at the CP and cervix in all patients (n=40). Membranes could not be visualized at the FW in 57.5% (n=23). Mean (± SD) MT (mm) at the CP, FW, and cervix differed significantly among these sites: 1.28 ± 0.17, 0.97 ± 0.14, and 0.55 ± 0.08, respectively (P<0.0001). MT at the CP increased as a function of gestational age (P = 0.005); however, a similar change was not detected for FW or cervix. CV for MT measurements ranged from 9.8 to 14.4% for intra-observer variability. Observations were made between 15-34.4 (median 25.4) weeks. Conclusion: 1) Mean MT throughout gestation differed significantly among CP, FW, and cervix; 2) FW membranes could not be visualized in 57.5%; 3) MT at the CP increased as a function of gestational age; 4) intra-observer variability was acceptable and was similar among sites; 5) reference values reported herein may be used to assess MT in cases of preterm labor and/or suspected intra-amniotic infection/inflammation.

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