Uterine Rupture Cases Over 15 Years in a District General Hospital: A Retrospective Case Series

ABSTRACT Objective To evaluate the incidence, clinical presentation, management, and maternal and neonatal outcomes of uterine rupture over a 15‐year period in a UK district general hospital, and to assess local practice against the Royal College of Obstetricians and Gynaecologists (RCOG) Green‐top Guideline No. 45. Design Retrospective case series. Setting Single UK district general hospital. Population Women with confirmed uterine rupture between January 2010 and June 2025. Only women who were booked and received antenatal care at our hospital were included; unbooked cases were excluded. Methods This clinical audit was approved by the hospital Audit and Quality Committee; individual consent was waived as data were anonymized and retrospectively collected. Cases were identified from maternity databases, incident reporting systems, and electronic medical records. Maternal, obstetric, labour, operative, and neonatal data were extracted using a standardized proforma and reviewed against national guidance. Main Outcome Measures Incidence of uterine rupture; maternal morbidity including haemorrhage, transfusion, hysterectomy, and intensive care admission; neonatal outcomes. Results Thirty‐two cases were identified, with 17 (53%) complete and 15 (47%) partial ruptures. Most women were multiparous (97%) with a scarred uterus (88%), commonly after one previous caesarean section. Four cases (13%) occurred in unscarred uteri, often associated with induction or oxytocin augmentation. Diagnosis was delayed in 72%. Major maternal morbidity included transfusion (41%), hysterectomy (9%), and intensive care admission (13%), with no maternal deaths. Neonatal outcomes were generally favourable, though one stillbirth and two intrauterine deaths occurred. Conclusion Uterine rupture is rare but serious, with significant maternal morbidity. Vigilance, cautious use of uterotonics, and prompt senior involvement are essential to optimise maternal and neonatal outcomes.