Catastrophic uterine rupture.

Twenty-three cases of major rupture of the pregnant uterus in which the life of the mother and/or fetus were endangered are presented. Fourteen cases (61.3%) resulted from rupture of a previous cesarean section scar. Rupture of an intact pregnant uterus in nine cases (38.7%) was related to oxytocic drug administration, obstetric manipulation, labor disorders, or external trauma. These most devastating cases were associated with grande multiparity. Rupture of the intact uterus was characterized by increased blood loss and need for transfusion. When compared with rupture of the scarred uterus, however, operating times and mortality rates were similar. Fetal mortality was 35% (eight of 23) and there were no maternal deaths.