PREGNANCY FOLLOWING RUPTURE OF THE PREGNANT UTERUS

Objectives: To review the cases of ruptured uterus at King Khalid Univ ersity Hospital (KKUH) over the 11 years of the hospital's existence ( 1984-1994), to analyze the causative factors of uterine rupture with a view to its prevention, and to highlight the management approach in r elation to maintaining the patients' future fertility. Methods: Case n otes were reviewed for all patients with ruptured uterus at KKUH over a period of 11 years from January 1984 to December 1994. Relevant data relating to the clinical features, characteristics of labor, operativ e procedures, and maternal and perinatal outcome were assessed. Result s: There were 11 cases of ruptured uterus, six of which occurred in pa tients with previous cesarean scars. Two patients were primigravidas, one of whom ruptured her uterus following a road traffic accident. In one patient with six previous preterm labors, rupture resulted from no n-removal of cervical cerclage during labor. The rupture occurred in t he fundus in one case, and in the lower segment in the remaining 10. F etal heart abnormalities were observed in all cases in which the uteru s ruptured during labor. Abdominal hysterectomy was performed in three cases, two of which were total and the third subtotal. The remaining eight patients had suture repair, all of whom became pregnant later an d were delivered by cesarean section. Conclusion: Even though rupture of the uterus was a rare complication of pregnancy at KKUH, its occurr ence should be suspected when there are sudden fetal heart abnormaliti es during labor, or unexplained postpartum shock. Suture repair should be considered whenever possible in order to preserve the patients' re productive potential.