A two-year review of uterine rupture in a regional hospital

Abstract

SUMMARYBackground: Uterine rupture causes high maternal and neonatal mortality in many rural setting in the world. Further studies might provide specific interventions to reduce the high prevalence. Objective: To determine the frequency, causes, clinical presentation, management and outcome of uterine rupture Setting: Department of Obstetrics and Gynaecology, Upper West Regional Hospital, Wa, Ghana. Design: Retrospective descriptive study. Method: A descriptive study of cases of ruptured uterus in the Regional Hospital from 1st January, 2007 to 31st December 2008 was done. A structured questionnaire was developed to collate data from various registers for analysis. Results: Total deliveries were 5085 with 4172(82%) spontaneous vaginal delivery and 911(17.9%) caesarean sections. Uterine rupture occurred in 41 cases for a ratio of 1:124 Grand multipara with five or more deliveries represented 41.5% while those with two prior successful deliveries represented 31.7%. The mean parity was 3.8 (SD 2.3) under antenatal care, 85.4% had at least four visits. Severe anaemia 28(68.3%) and abdominal tenderness 27(65.8%) were the most frequent clinical presentation while the use of local herbal concoction with suspected uterotonic activity 24(58.5%), fetopelvic disproportion 4 (9.8%) and malpresentation 5(12.1%) were the most significant causes. Major complications were: neonatal deaths 34(82.9%), maternal mortality 4(9.8%) and wound infections 15 (36.6%). Subtotal hysterectomy 10(24.4%) and total hysterectomy 18(43.8%) were preferred to uterine repair 12(23.3%) and 87.8% required at least two units of blood transfusion. Conclusion: skilled attendance with accessible emergency obstetric care and focused antenatal care are key elements for the prevention and management of uterine rupture.

Case analysis of complete uterine rupture in a tertiary health care center

“…7,12 In Nigeria , Ghana, Ethiopia and Bangladesh, incidence of about 75% of cases of uterine rupture were associated with unscarred uterus. 4,7,13 53.83% of women with uterine rupture underwent rent repair in our study, which was comparable to other Indian studies. Most of the studies from African countries and few from Pakistan showed that significant number of rupture uterus cases managed by repair with bilateral tubal ligation.…”

“…Among the developing countries, the incidence varied in 1:124 (0.8%) in Ghana, 0.74% in Pakistan, 0.9% in Nepal and 2.8% in Ethiopia. [4][5][6][7] The incidence in developed countries is recorded at least ten times lower (0.035%). This wide variation in incidence is due to socio-economic factors, cultural practices and lack of access between to antenatal and intrapartum care.…”

Rupture uterus: a prospective observational study of 25 consecutive cases in a tertiary referral centre in South India

“…12 But in developing countries late symptoms and signs are the ones that clinch the diagnosis. 15 In 84% of our subjects, the rupture of the uterus was complete. In other studies, complete rupture was noted in 66% by Sahu L, 57.1% by Dhaifalah I and 88% by Sunitha K. 8,20,6 In 52%, the tear involved the previous uterine scar or the anterior wall.…”

“…All 25 women required blood transfusion, which is not the case in most of the studies including those from African countries. 5,8,15 The reason for such high rates of blood transfusion in our women could be that most of them start the pregnancy with anaemia. Haemoglobin at time of admission was less than or equal to 8 gm% in 56% of the women.…”

“…In our study, the incidence of rupture uterus was 0.11%, which was much less compared to the incidence reported from other developing countries; 0.8% in Ghana, 0.76% in Uganda, 0.74% in Pakistan, 0.9% in Nepal, 2.8% in Ethiopia and 0.63% in Yemen. [15][16][17][18][19][20] Studies from developed countries showed incidences as low as 0.035%. 21 The incidence in other Indian studies is comparable to our study varying from 0.061% to 0.28%.…”