Risk factors and perinatal outcome of uterine rupture in a low-resource setting

Abstract

Background:Uterine rupture has continued to be a catastrophic feature of obstetric practice especially in the low-resource settings. This study determined the incidence, predisposing factors, treatment options and feto-maternal outcome of ruptured uterus.Materials and Methods:A 10-year retrolective study of all cases of uterine ruptures that were managed in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria between 1st January, 2001 and 31st December, 2010 was undertaken. The proforma was initially used for data collection, which was transferred to a data sheet before entering them into the Epi-info software. Analysis was done using Epi info 2008 (version 3.5.1).Results:Out of 5,585 deliveries over the study period, 47 had uterine rupture, giving an incidence of 0.84% or 1 in 119 deliveries. All the patients were multiparous and majority (63.8%) was unbooked. Traumatic (iatrogenic) rupture predominated (72.1%). Uterine repair with (55.8%) or without (34.9%) bilateral tubal ligation was the commonest surgery performed. Case fatality rate was 16.3%, while the perinatal mortality rate was 88.4%. Average duration of hospitalization following uterine rupture was 10.3 days.Conclusion:Uterine rupture constituted a major obstetric emergency in the study hospital and its environs. The incidence, maternal and perinatal mortalities were high. The traumatic/iatrogenic ruptures constituted the majority of cases, hence, majority of the cases are preventable. There is therefore a dire need for education of our women on health-related issues, utilization of available health facilities, adequate supervision of labour and provision of facilities for emergency obstetric care.

Fetomaternal outcomes in patients with Uterine Rupture managed at Bugando Medical Centre, Tanzania: 5-year review of cases

“…This is equivalent to case fatality rate of 1.5% similar to a study done in UK which reported a case fatality rate of 1.3% [33]. This is contrary to other studies done in Africa where maternal case fatality rates were reported to be high, 6% -16% [1,3,12,34].…”

“…Uterine rupture is one of the major obstetric catastrophic events which may be associated with severe hemorrhage, hysterectomy, genitourinary injury and maternal death [1][2][3][4][5]. According to World Health Organization (WHO), the incidence of uterine rupture is high and a serious problem in developing countries ranging from 0.1% to 1% [4].…”

Dachshund bitch with severe uterine adhesions and intramural uterine foreign material as an incidental ovariohysterectomy finding

“…Of those cases, 44.2% received oxytocin and had a prior uterine scar, 18.6% received oxytocin without having a prior scar, 13.9% received no oxytocin but had a prior scar, 9.3% had increased fundal pressure, 4.7% had an obstructed labour and 4.6% were identified as classical caesarean section patients. Of the ruptures, 88.4% were complete and 11.6% were incomplete …”

“…One study found 6.2 cases of uterine rupture per 1000 vaginal deliveries in women who had previously undergone a caesarean section . Another study of 5635 women found that uterine scar dehiscence did not increase the risk of uterine rupture …”

“…A retrospective study over 10 years of 5585 women in a low‐resource setting found that the highest risk factor for uterine rupture was receiving oxytocin when a uterine scar was present . That study found a uterine rupture incidence of 0.84%.…”