Abstract
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. To determine the frequency, causes, clinical presentation, management and outcome of uterine rupture Department of Obstetrics and Gynaecology, Upper West Regional Hospital, Wa, Ghana. Retrospective descriptive study. 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. 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. skilled attendance with accessible emergency obstetric care and focused antenatal care are key elements for the prevention and management of uterine rupture.
Highlights
Indigenous people in Africa and other parts of the world have relied on prayers, rituals and sacrifices to gods to control obstetric accidents and maternal mortality
Attempts to imitate the success story of western countries in lowering maternal mortality drastically have failed in Africa because the poor majority still do not have access to the basic life saving techniques, the persistent unacceptably high maternal mortality ratio
Uterine rupture stands as a single obstetric accident that exposes the flaws and inequities of health systems and the society at large due to the degree of neglect that it entails
Summary
Indigenous people in Africa and other parts of the world have relied on prayers, rituals and sacrifices to gods to control obstetric accidents and maternal mortality. In 2005, an estimated 536,000 women died from causes related to childbirth in the world and 95% were from Africa and Asia.[1] Ghana, similar to many sub-Saharan countries is still burdened with a maternal mortality ratio between 214 and 820 per 100 000 live births[2], mostly from preventable causes. Uterine rupture is a potentially catastrophic event during childbirth in which the integrity of the myometrial wall is breached.[3] In a complete rupture there is full-thickness separation of the uterine wall with the expulsion of the foetus and/or placenta into the abdominal cavity where-as the overlying serosa or peritoneum is spared in an incomplete rupture.3,4This obstetric accident is closely associated with maternal and/or foetal mortality and morbidity such as bladder rupture, vesicovaginal and rectovaginal fistula, foot drop and psychological trauma
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