A 10-Year Retrospective Analysis of Uterine Rupture in a University Teaching Hospital in Nnewi, Nigeria

Abstract

Background: One of the most serious obstetric emergencies that seriously endanger both mother and fetus and dramatically increase maternal and perinatal mortality in our community is uterine rupture. The aim of the study is to ascertain the prevalence of uterine rupture and the various aetiologies/predisposing factors associated with it. Methods: From January 1, 2007, to December 31, 2016, patients with ruptured uteruses were studied retrospectively and cross-sectionally at the Nnamdi Azikiwe University Teaching Hospital in Nnewi, Nigeria. Outcome measures included prevalence rate, surgical choices, maternal and fetal outcomes, and maternal case fatality rate. Stata 13.0 (StataCorp LP, Texas, USA) was used to analyze the data. Results: There were 10,777 deliveries and a total of 66 cases of ruptured uterus were treated, giving a ratio of 1 in 163 deliveries or prevalence of 6.0/1000 deliveries. Sixty four case notes were retrieved giving retrieval rate of 97.0% and prolonged obstructed labour was the commonest aetiologic factor identified (42.2%). Other associated factors were grand multiparity (36.0%), previous caesarean section (28.1%), previous myomectomy (3.1%), injudicious use of oxytocin (25.0%), use of misoprostol (3.1%) and abnormal lie (17.2%). Twenty of the patients (31.3%) had repair of the ruptured uterus alone, and 28(43.8%) had repair with bilateral tubal ligation. Six of the patients (9.4%) had total abdominal hysterectomies while 10(15.6%) had sub-total hysterectomies. There were a total of 4 maternal deaths giving a case fatality rate of 6.3%. The fetal outcome was poor with only 11 (17.2%) survivors. Conclusion: Only 17.2% of surviving fetuses had a good result, and 6.1 per 1000 deliveries involved uterine rupture. The rupture of gravid uterus will be decreased, if not completely eliminated, by adequate health education, widespread availability of comprehensive obstetric care facilities, enhanced antenatal care, a decline in the prevalence of primary caesarean sections, and population empowerment of women