10 years experience with conservative surgical approach to ruptured uterus.

36 cases of ruptured uterus were seen among 22651 deliveries at Dr. B.L. Kapoor Memorial Hospital during the period January 1984 to January 1994. This condition is one of the most serious obstetrical complications resulting in high maternal and perinatal mortality with hysterectomy considered by many to be the standard management of the condition. The patients were aged 22-36 years (average age 25.8 years). Rupture was recognized antepartum in one patient and intrapartum in the remaining cases. With the goal of minimizing the level of maternal mortality all ruptures were treated by simple repair irrespective of duration and size. Immediate laparotomy combined with resuscitative measures was employed. There were no postoperative complications and the patients were discharged in a satisfactory condition. Overall maternal mortality was 2.78% while perinatal mortality was 97.2%. Early diagnosis and quick laparotomy saved one baby. Three patients conceived again and had an elective classical cesarean section at 37 weeks. Although tubectomy is recommended following treatment for ruptured uterus women who refuse to undergo sexual sterilization must be carefully monitored during their next pregnancy. Continuous fetal monitoring and delivery at 36-37 weeks by cesarean section seems the best approach in such cases.