Trends in uterine rupture in Enugu, Nigeria

Abstract

Our objective was to determine the trend of rupture of the gravid uterus at Enugu, Nigeria and to determine any change in pattern of presentation, management and outcome of such patients. The birth register of 4,333 deliveries at the University of Nigeria Teaching Hospital Enugu from January 1997 and December 2000 were reviewed. Forty-one cases of ruptured uterus were identified and analysed. The incidence of uterine rupture was 1 in 106 deliveries with a mean maternal age of 31.2 years. The majority (75.6%) of the patients were multiparous and had some form of antenatal care (61%) with 19.5% of the total booked at the Teaching Hospital. Many (78.1%) of the patients were in labour for 24?hours or less and 22.0% had oxytocin to augment or induce labour. The majority (68.3%) had a previously scarred uterus and many (53.6%) had lower segment ruptures. At laparotomy 31.7% had repair alone, 29.2% had repair with tubal ligation, 22.0% subtotal hysterectomy and 17.1% total hysterectomy. Perinatal mortality was high (87.8%) and maternal mortality rate 48.8 per 1,000 deliveries. Labour in a previously scarred uterus was the most common aetiological factor followed by obstructed labour in a multiparous woman. The incidence of ruptured uterus is still rising at Enugu, Nigeria but maternal mortality, due to uterine rupture continues to fall. The most commonly performed surgery is repair with or without sterilisation rather than hysterectomy.

Uterine rupture: the road ahead?

“…Two studies from Nigeria reported on uterine rupture. In the first study, 21% of patients had no uterine scar, and prolonged labour and grand multiparity were associated with the rupture [27]. The incidence of uterine rupture in this study was 1 in 106 births (=9.4/1,000).…”

Averting Maternal and Perinatal Mortality in Nigeria; Establishment of Obstetric Waiting Units; Targeting Uterine Rupture

“…5 Rupture of the gravid uterus is an obstetric catastrophe mostly domiciled in developing countries of the world especially in sub-Saharan Africa. 1,[10][11][12][13][14][15] This model is targeted at ruptured uterus because it is beginning to emerge as a common cause of maternal and perinatal mortality in our environment. 1 Obstructed labour is a major cause of maternal mortality and a common cause of ruptured uterus from previous literatures.…”

“…17 However, the trends have begun to change especially in this part of the world where traditional/unskilled birth attendants are carrying out a lot of unconventional birth practices (abdominal massage) predisposing parturients to ruptured uterus. [11][12][13][14][15] In addition, previously, ruptured uterus was associated with women of high parity in contrast to the current trends in which ruptured uterus is also seen amongst women of low parity. 1,[11][12][13][14][15]19 Looking at these emerging problems in our society what are the most likely causes?These include social/cultural factors, ignorance, religious factors, economic factors and poor infrastructure/transportation.…”

“…[11][12][13][14][15] In addition, previously, ruptured uterus was associated with women of high parity in contrast to the current trends in which ruptured uterus is also seen amongst women of low parity. 1,[11][12][13][14][15]19 Looking at these emerging problems in our society what are the most likely causes?These include social/cultural factors, ignorance, religious factors, economic factors and poor infrastructure/transportation. 1,15,19 Due to age-old customs and traditional beliefs, some cultures see it as a taboo to deliver in conventional health facilities.…”

“…12 They believe in taking deliveries under the care of traditional birth attendants who often resort to unorthodox practices, such as fundal pressure and abdominal massage. 10,11 In addition,when progress in labour is delayed and referralsare unjustifiably delayed, the mothers and babies are at increased risk of dying if dystocia/obstruction sets in. 16,17 Ignorance and illiteracy are highly tied to religious factors, where faith based organizations have resorted to conducting childbirths at their places of worship, with little or no skilled supervision and in some scenarios with the injudicious use of oxytocics, even withprevious uterine scars (caesarean sections/previous myomectomies).…”