Uterine Rupture - Risk Factors and Pregnancy Outcome in Bundelkhand Region

BACKGROUND Uterine rupture is defined as the tearing of the muscular wall of the uterus during pregnancy or labour.1 Often it occurs from the tearing of previous caesarean scar during labour.2 The other known risk factors for uterine rupture include, maternal age, height, body mass index (BMI), education, birth weight, gestational age, induction of labour, instrumental vaginal delivery, interpregnancy interval, congenital uterine anomaly, grand multiparity, previous uterine surgery, fetal macrosomia, fetal malposition, obstructed labour, uterine instrumentation, attempted forceps delivery, external version, and uterine trauma. 2-6This study was done to find out the prevailing risk factors associated with this grave condition in Bundelkhand region, so that mortality and morbidity associated with it could be prevented. METHODS We have studied 37 cases of uterine rupture, operated in our institution from Jan. 2018 to Oct. 2019. During this period a total of 2986 Caesarean sections (CS) were performed. Of these 37 cases, 5 were Nullipara (13.51 %), 16 primipara (31.25 %) and 16 were grand multipara (31.25 %). 24 cases (64.86 %) had previous uterine scar while 13 (35.13 %) had no scar. RESULTS In our study major risk factors for uterine rupture were found to be previous scars (64.68 %). Obstructive labour (23.07 %), malpresentation (7.69 %), grand multiparity (38.46 %) and prolong labour (30.76 %), were responsible for rupture in unscarred uterus. In all cases we first tried to repair the tear and only 9 (24.32 %) needed hysterectomy. In our study 28 patients (75.67 %) required only repair whereas 24.32 % cases needed hysterectomy. Maternal death was just 1 case (2.7 %) and (51.35 %) babies survived. CONCLUSIONS Majority of uterine rupture cases were found in women who had previous CS. So, first CS should be performed after very careful understanding of its indications. 2.7 % maternal mortality and 51.35 % delivery of live birth babies in our study proves that early detection and proper managing of the case can reduce maternal and fetal mortality in uterine rupture cases. KEY WORDS Uterine Rupture, Previous Scar, Inter-Pregnancy Interval

Abstract P178: The Association Between Multiparity And Endogenous Sex Hormone Levels In The Multi-ethnic Study Of Atherosclerosis (mesa)

Introduction: Parity is a risk factor for adverse cardiovascular events in women compared to nulliparity. A more androgenic sex hormone profile, with increased testosterone to estrogen ratio, is associated with worse cardiovascular disease (CVD) outcomes in women and may be one mechanism that links a history of multiparity with future increased CVD risk. Given this, we investigated the relationship between parity and sex hormone levels. Methods: We studied 3,003 female MESA participants (ages 45-84 years and free of CVD) with complete data on parity and endogenous sex hormone levels at the baseline visit (2000 - 2002). Parity (number of live births) was categorized as 0 (reference), 1-2, 3-4, or ≥5. Progressively adjusted linear regression models were used to evaluate the association of parity categories with log-transformed levels of testosterone (T), estradiol (E2), sex-hormone binding globulin (SHBG), dehydroepiandrosterone (DHEA), and testosterone to estradiol (T/E2) ratio. Results: Mean (SD) age at the baseline MESA visit was 65 (9) years. Median sex hormone levels by parity group are shown in the Table . There were no significant associations of parity with E2, DHEA, and SHBG levels in multivariable-adjusted models. Compared to nulliparity, women with 1-2 and 3-4 live births had higher testosterone levels even after adjustment for CVD risk factors, but this was not significant for ≥5 live births. On the other hand, grand multiparity (≥5 live births) was associated with a higher T/E2 ratio compared to nulliparity, even after full covariate adjustment including demographics, lifestyle factors, CVD risk factors and medications. Conclusions: In a multiethnic US cohort of women, a history of grand multiparity is associated with a more androgenic sex hormone profile defined by higher T/E2 ratio at middle to older ages. The clinical significance of this is uncertain. Further longitudinal studies evaluating whether sex hormones influence the relationship between multiparity and CVD are warranted.

Submucosal Uterine Fibroid in Grand Multipara Woman: A Case Report

Background: to report and analyze a case that diagnosed with submocous uterine fibroid in grand multiparity woman. Methods: Case Report Case: a 49 years woman, P7A0 came with chief complaints vaginal bleeding that has been experienced since one year ago getting worse in 2 months. Her general condition was within normal limit and there was no abnormality in physical examination, by vaginal examination there was blood in the vagina, origin from the External Uterine Orificium (EUO),bimanual examination showed anteflexion uterus with normal size, right and left adnexa within normal limits. From transvaginal ultrasound we found submucous uterine fibroid size 3 x 3 cm, we decided to perform Total Abdominal Hysterectomy. Conclusion: Hysterectomy is a progressive and definitive uterine fibroid procedure. For women who do not want to conceive and/or women over 40-50 years of age, in particular.

Antenatal Complications in Grand Multipara Presented at Tertiary Care Hospital

Background: Grand multiparity considered as a risk factor of obstetrics because of the recorded complications linked to the condition. Grand multiparity typically considered as the distinctive reason for the raised, maternal and fetal morbidity and mortality because of expanded incidence of adverse outcome during pregnancy and birth. Objective: To determine frequency of antenatal complications in grand multipara. Study Design: Cross-sectional study. Settings: Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre, Karachi Pakistan. Duration: Study duration was six months from March 2016 September 2016. Methodology: Total 212 patients were included in this study. Anemia was taken as Hb of 11g/dl, PIH was taken as BP of >140/90mmHg after 20 weeks of gestation with or without proteinuria on two or more occasion 6 hours apart and placenta previa was confirmed via ultrasonography. All the information was collected via study proforma. Results: Patients mean age was 34.90±3.51 years. Most of the patients 96.7% had parity 5-9. Anemia was found 69.8% and pregnancy induced hypertension was 22.2%, while placenta previa was found to be 18.9%. Antenatal complications including anemia, pregnancy induced hypertension and placenta previa were found to be statistically insignificant according to age, parity and BMI, (p->0.05). Conclusion: Most common antenatal complication in this study was anemia followed by hypertension and placenta previa. Grand multiparity is at a greater risk of antenatal complications.

MATERNAL OUTCOME OF GRAND MULTIPARITY

Increased maternal and foetal complication is observed in cases with increased parity. In this study 80 grand multipara patient who had previous four or more pregnancy were recruited for study and found to be increased complication among them. Around 15% had multiple pregnancy and 15% had malpresentation whic is quiet higher in comparison to the normal population.