A desperate destructive procedure by a laywoman with disastrous consequences – An unusual case

Uterine rupture, a dramatic obstetric emergency occurs more commonly in the underdeveloped countries, where it is still a significant problem (1). It is a major cause of maternal mortality in many Asian and African countries. Uterine rupture in developed countries usually presents in a manner, which is quite different from that often seen in less developed region of world (2). The most common cause of uterine rupture in the developed world is the previous caesarean scar. In contrast injudicious use of oxytocin and obstructed labour are the most common cause in the developing countries (3). Other known risk factors include a history of myomectomy, cephalopelvic disproportion, fetal malpresentation, breech version, operative delivery, trauma, grand multiparity, prostaglandin induction for abortion and electromyolysis (4). With improvement in obstetrical care, stormy obstetrical emergencies have become very rare and seldom destructive operations are required. However, in Uttarakhand, a hilly region the population is sparse and living in far flung areas where, medical facilities are inaccessible. Therefore, desperate obstetrical emergencies managed by unskilled dais (indigenous untrained midwives) and relations are frequently encountered in this tertiary care hospital. We report one such case here.