Subtotal hysterectomy for uterine rupture

Objective: The aim of this paper was to stratify patients with uterine rupt ure in extremis (with hypotension, change in vital organ function, and alte red mental status) and evaluate outcome for patients undergoing subtotal hy sterectomy (STH) vs. uterine repair (UR). Methods: Of 39 667 hospital deliv eries between 1993 and 1998 at a university hospital, 367 presented with ut erine rupture. Of these, 96 presented in extremis and had an irregularly to rn uterus found at operation. Charts were retrospectively reviewed to strat ify patient population with uterine rupture and their outcome. Results were analyzed using Fisher's exact test. Results: Patients with uterine rupture were 31-35 years old, para greater than or equal to 3, had received no ant enatal care, and presented with rupture in the lower uterine segment. Sixty -one patients underwent STH while 35 underwent UR. The groups were similar with respect to patient age, parity, cause of rupture, and clinical conditi on at the time of evaluation (P = 0.2). The operative time for STH was sign ificantly less than UR, 35 min vs. 75 min (P < 0.01). Maternal mortality wa s significantly higher in patients undergoing UR vs. STH, 46% vs, 20% (P = 0.01). Maternal morbidity occurred in 30% of patients undergoing STH vs. 50 % in patients undergoing UR(P = 0.01). The time to discharge was significan tly less in patients undergoing STH compared to UR, 14.5 days vs. 27 days(P < 0.01). Conclusions: Patients with uterine rupture in extremis tend to be young, multiparous, receive no antenatal care, and have uterine rupture of the lower segment. STH significantly lowered operative time, morbidity, ti me to discharge, and mortality than UR in patients in extremis with uterine rupture, (C) 2001 International Federation of Gynecology and Obstetrics. A ll rights reserved.