Ruptured uterus at the Korle‐Bu Teaching Hospital, Accra, Ghana

Maternal Death After Uterine Rupture in an Unscarred Uterus: A Case Report

“…However, the true incidence of uterine rupture is difficult to ascertain because the cause of maternal death due to obstetric shock remains obscure in a number of cases. The reported incidences of spontaneous rupture of the unscarred uterus range from 1 in 8000 to 1 in 15,000 deliveries (7,8). Maternal mortality resulting from uterine rupture ranged from 0 -44%, and the overall mortality was 15.9 % (219 maternal deaths from 1381 uterine rupture cases) (9).…”

Uterine Rupture in Resource-Poor Countries

“…67,68 Aggressive manipulation of the uterus (such as the application of forceful fundal pressure) may also be used by untrained traditional birth attendants 3,5,8,20,47,51 or by inadequately trained health care workers, who sometimes attempt to perform heroic obstetric maneuvers (such as internal podalic version or breech extraction, especially of a retained second twin) without adequate resources or supervision. [1][2][3]5,[7][8][9]11,14,16,20,23,26,[31][32][33][34]38,41,53 Many cases of uterine rupture are associated with difficult instrumental delivery 1,2,6,8,15,16,20,23,27,[30][31][32][33][39][40][41]43,50,52 or destructive obstetric procedures such as craniotomy or decapitation of a dead ...…”

“…The site of rupture may be posterior, fundal, lateral (sometimes involving 1 or both uterine arteries), as well as anterior or may extend from the lower segment up to the fundus or down into the cervix and/or the vagina. 32,33,39,43,45,59 It is imperative that each patient with uterine rupture be examined fully and carefully at the time of laparotomy so that life-threatening injuries that require operative repair are not missed.…”

“…Review of case series in which bladder injuries were specifically reported shows that roughly 13% of uterine ruptures in lowresource countries also involve the bladder (range, 1.9%-65.3%). 1,2,5,6,8,[12][13][14]16,18,21,22,24,26,30,32,33,39,43,45,47,[50][51][52][53][56][57][58][59]61 If the uterus is ruptured, the integrity of the bladder must be assessed. Many patients with uterine rupture will develop a vesicovaginal fistula, particularly if the rupture is associated with obstructed labor.…”

Vaginal birth after cesarean delivery in the West African setting

“…Moreover, the rates of infectious morbidity are higher among women who had an unsuccessful TOL [16], and uterine rupture is more common when the fetal weight is greater than 4000 g, especially in women with no history of vaginal delivery [9]. A scarred uterus was the second most common cause of uterine rupture at KBTH [19,20].…”