Uterine Rupture: Scarred versus Unscarred Uterus — Perspective from Low- and Middle-Income Countries.

In low- and middle-income countries (LMICs), where delayed referral, insufficient intrapartum surveillance, and limited emergency surgical capability continue to exacerbate maternal and neonatal risk, uterine rupture continues to be one of the most devastating obstetric crises. This retrospective analytical study, conducted at PIQSJIMS Gambat, reviewed 80 cases of uterine rupture from January 2019 to December 2023 (ERC#389). Patients were categorized into rupture of unscarred and scarred uteri, and cases with incomplete data or uterine dehiscence were excluded. Variables including hemorrhage, surgical intervention, ICU admission, cervical trauma, delivery outcomes, and maternal mortality were analyzed using Chi-square tests (p < 0.05). Results showed that massive bleeding (>1000 mL with shock) was more common in instances with scarred uterus, but major bleeding (500–1000 mL) was more common in unscarred uterine rupture. Uterine repair predominated in unscarred rupture, but subtotal hysterectomy was considerably greater in the scarred uterus group (p=0.02). Unscarred rupture was substantially correlated with cervical trauma (p=0.01). While dead-on-arrival cases were more common in unscarred ruptures (p=0.014), maternal mortality was considerably greater in women with scarred ruptures (p=0.009). There was a significant difference in delivery status across the groups (p=0.006). Hence, it is concluded that there are notable distinctions in the patterns of scarred and unscarred uterine rupture; scarred rupture is related with greater rates of surgical removal and death, whereas unscarred rupture is linked to pre-delivery diagnostic and cervical trauma. Reducing the incidence of uterine ruptures in LMICs requires improved intrapartum monitoring, prompt surgical preparedness, and robust referral networks.