To review the incidence, associated factors, methods of diagnosis, and maternal and perinatal morbidity and mortality associated with uterine rupture in one Canadian province.
Using a perinatal database, all cases of uterine rupture in the province of Nova Scotia for the 10-year period 1988-1997 were identified and the maternal and perinatal mortality and morbidity reviewed in detail.
Over the 10 years, there were 114,933 deliveries with 39 cases of uterine rupture: 18 complete and 21 incomplete (dehiscence). Thirty-six women had a previous cesarean delivery: 33 low transverse, two classic, one low vertical. Of the 114,933 deliveries, 11,585 (10%) were in women with a previous cesarean delivery. Uterine rupture in those undergoing a trial for vaginal delivery (4516) was complete rupture in 2.4 per 1000 and dehiscence in 2.4 per 1000. There were no maternal deaths, and maternal morbidity was low in patients with dehiscence. In comparison, 44% of those with complete uterine rupture received blood transfusion (odds ratio 7.60, 95% confidence interval 1.14, 82.14, P =.025). Two perinatal deaths were attributable to complete uterine rupture, one after previous cesarean delivery. Compared with dehiscence, infants born after uterine rupture had significantly lower 5-minute Apgar scores (P
During a four year period, 60 patients with premature rupture of membranes (PROM) met the inclusion criteria of having a single living fetus with gestational age between 25 to 36 weeks and more than 24 hours between PROM and delivery were admitted in Karolinska Hospital, Sweden. These cases were reviewed retrospectively. Five neonates died postnatally and the total survival rate was 91.7%. Three of them had major malformations and one died of hyaline membrane disease with 29 weeks of gestational age. In only one case the immediate cause of death was due to infection. The present protocol of expectant treatment for PROM in this hospital tends to be a minimum of unnecessary intervention for obtaining a high survival rate.
A retrospective study was made of the management of abdominal aortic aneurysms in eight district general hospitals in Sweden in the period 1971-1980. The numbers of admitted cases rose steadily during these ten years, as did the numbers of operations. Most of the patients had ruptured aneurysm, though there was a manifold rise in the number of operations for asymptomatic aneurysm. The postoperative mortality increased with the level of emergency presented by the aneurysm symptoms, and was about 80% in patients with clinical shock. The results of operative treatment were essentially stable during the study period and they appeared to be similar to those obtained in patients referred to units specializing in vascular surgery. Patient age, preoperative recognition of the diagnosis, concomitance of complicating disease and magnitude of peroperative blood loss seemed to influence the results of surgery. Postoperative deaths tended to occur in the first few days and to be independent of the volume of transfused blood, although severe bleeding was a significant and often fatal postoperative complication.
A prospective, observational, multicentre study has been carried out on 444 consecutive patients with abdominal aortic aneurysms to study the effect of the diffusion of vascular service on treatment results. Two-hundred and seventy-nine patients were admitted for elective surgery (E), 114 patients had a ruptured aneurysm (R), and 51 had impending rupture (IR). Patients with acute symptoms (R + IR) were generally older and had larger aneurysms than the E group. The postoperative mortality was 7.5%, 16.7%, and 63.1% in the E, IR and R group respectively. The study demonstrates that overall treatment results in these high risk patients are inferior to results published from specialised institutions. Consequently, the diffusion of vascular surgical service seems not to have worked to the benefit of our patients although further analysis may modify this conclusion.
In the 6 1/2 years ending June 1977, 210 patients with abdominal aortic aneurysms underwent operation at Toronto Western Hospital; 160 aneurysms (76%) were unruptured and 50 (24%) were ruptured. In the patients with unruptured aneurysms the mean age was 68 years; the oldest was 91, and 12 were more than 80 years of age. The overall hospital mortality was 5.6%. Death in hospital occurred in 1 (1.2%) of the 83 asymptomatic patients, 4 (7.4%) of the 54 symptomatic patients and 4 (17.0%) of the 23 patients for whom operation was considered urgent. In the patients with ruptured aneurysms the mean age was 71 years; the oldest was 90, and five were more than 80 years of age. The overall hospital mortality was 54%. The morbidity and mortality were analysed; in particular the reasons for the markedly variable hazard of operations for the three categories of unruptured aneurysm were sought. The surgical literature is confusing because of the interchanging use of the words unruptured, elective and symptomless. The current philosophy management and technique of operation in a large cardiovascular surgery service with many trainees are presented and a plea is made for a standardized and simplified operation, always performed with three assistants helping the operating surgeon.
Cites: Can Med Assoc J. 1963 Oct 5;89:705-814065073
Cites: Can Med Assoc J. 1977 Jul 23;117(2):147-50872011
Cites: N Engl J Med. 1973 Apr 5;288(14):695-94631743
A retrospective study has been carried out on 124 consecutive patients with abdominal aortic aneurysms admitted during the period 1960-74. The mortality rate after emergency operation was 56 per cent and after elective operation 15 per cent. As in other vascular centres during these years the mortality rate has decreased among electively operated patients. We have tried to answer two questions: which patients without signs of rupture should undergo operation and which patients with a ruptured aneurysm should not be operated upon?