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Introduction: Uterine rupture remains one of the top catastrophic events in the field of Obstetrics. Management options are often surgical and limited to either fertility sparing versus complete loss of reproductive function. In the developing world, uterine rupture can have devastating maternal and/or fetal outcomes due to delayed recognition and/or intervention. With medical advancements over the years as well as the significant increase in cesarean delivery rates worldwide, it is beneficial to determine how the management of uterine rupture has evolved worldwide.
Methods: A literature review was conducted in PubMed database over the last 30 years. Journal articles that described the surgical management of uterine rupture were selected and reviewed. The incidence of uterine rupture was noted, as well as the most common etiologies and management strategies.
Results: The incidence of uterine rupture ranged from 0.015 to 3.76% across various countries. The two most common etiologies of uterine rupture were obstructed or neglected labor and a scarred uterus. Prior to 2010, uterine rupture involved a scarred uterus in 6.2 to 46.7% of cases. Reviews from 2010 onward reported prior scarred uteri as a cause of uterine rupture 66-100% of the time. Hysterectomy was overall the most common surgical method employed in greater than 50% of the cases prior to 2010. From 2010 onward, 77-100% of uterine ruptures were managed with uterine repair with or without bilateral tubal ligation.
Conclusion:As cesarean deliveryrates have increased worldwide, the etiology of uterine rupture has shifted from that of obstructed labor to that of the scarred uterus. As a result surgical management of uterine rupture has also shifted from primarily hysterectomy to mostly uterine repair, as the presentation of these ruptures are less catastrophic.
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