Peer-reviewed article
Incidence and Predictors of Uterine Rupture with Maternal and Perinatal Outcome: A Cross-sectional Study.
Pipal VR, Singh RK, Singh A, Singh PB, Singh N et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined uterine rupture cases at a hospital in Eastern India over 12 months, finding an incidence of 8.7 per 1,000 deliveries, which is much higher than the national average. Previous cesarean delivery followed by unsupervised labor was the main risk factor. While most mothers survived, nearly all newborns died (96.77% perinatal mortality), highlighting the urgent need to improve antenatal care and safe delivery practices in rural India.
Key points
- Incidence of uterine rupture was 8.7 per 1,000 deliveries, markedly higher than India's national average
- Previous cesarean section with unsupervised labor was the leading risk factor for uterine rupture
- Maternal mortality rate was 6.45%, with 83.87% of women recovering without major complications
- Perinatal mortality was extremely high at 96.77%, with only one neonate surviving out of 31 cases
- Unsafe labor practices and poor antenatal care were identified as key drivers of uterine rupture in the region
Limitations
This is a descriptive cross-sectional study at a single tertiary care center, so the findings may not be generalizable to other regions of India or different healthcare settings. The study documents what occurred but does not evaluate the effectiveness of any intervention to prevent uterine rupture.
Abstract
Background and objective Although maternal mortality in India has declined significantly due to improved healthcare access and government initiatives, uterine rupture is re-emerging as a serious obstetric complication, largely driven by the rising incidence of cesarean deliveries. This study was conducted to evaluate the incidence, risk factors, and maternal and fetal outcomes of uterine rupture at a tertiary care center in Eastern Uttar Pradesh, India. Methods An observational cross-sectional study was conducted over 12 months (October 2019-September 2020) in the gynecology inpatient department of a tertiary care center. All clinically diagnosed and laparotomy-confirmed cases of uterine rupture were included. Maternal demographics, antenatal and perinatal risk factors, intraoperative findings, and maternal and fetal outcomes were analyzed. The occurrence of uterine rupture during COVID and non-COVID periods was compared using a Z test for proportion. The incidence was calculated from the total number of hospital deliveries during the study. Results Of 3,552 deliveries, 31 cases of uterine rupture were reported, yielding an incidence of 8.7/1,000- markedly higher than the national average. The incidence during the COVID-19 period increased, but was not statistically significant. Previous cesarean section (CS) with unsupervised labor was the leading risk factor. Maternal mortality was 6.45%, and 83.87% of women recovered without major complications. Perinatal mortality was alarmingly high at 96.77%, with only one neonate surviving. Conclusion and global health implications Uterine rupture remains a significant contributor to maternal and perinatal mortality in rural India, particularly due to unsafe labor practices and poor antenatal care. There is an urgent need to strengthen health systems, referral networks, and community education to prevent uterine rupture and improve maternal-child health outcomes. In addition, focused efforts are required to reduce the rate of unnecessary CS through adherence to evidence-based guidelines and promoting safe vaginal births when appropriate.