Incidence and Predictors of Uterine Rupture with Maternal and Perinatal Outcome: A Cross-sectional Study.

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.