Clinical, Therapeutic and Epidemiology Aspects of Uterine Rupture in the Gyneco-Obstetrics Departement of the Sikasso Hospital

Abstract

Introduction: Uterine rupture is one of the main causes of maternal and fetal mortality in Mali. Method: This was a descriptive cross-sectional prospective study in the Gynecology - Obstetrics department of the Sikasso hospital from January 01, 2018 to June 30, 2019, i.e. eighteen months. The study covered all cases of childbirth recorded in the Gynecology - Obstetrics Department of Sikasso Hospital during the study period. Results: During these 18 months of study, we recorded 68 cases of uterine rupture out of a total of 4,815 deliveries, ie a frequency of 1.41%. Regarding the mode of admission, 93% were evacuated against 7% who came on their own. For the evacuated patients, 82.4% arrived by ambulance against 13.2% by personal car and 4.4% by public transport. The duration of labor was ≥ 12 hours in 22.1% of cases. Lesions were associated with rupture in 19.1% of cases. The use of uterotonics was responsible for uterine rupture in 54.4% of cases and 7.4% of patients had a generally narrowed pelvis. Simple hysterorrhaphy was performed in 30%, hysterorrhaphy associated with tubal ligation resection in 50% and subtotal hysterectomy in 20% of cases. Lack of schooling, the lack and poor quality of prenatal care have been factors that increase maternal and perinatal morbidity and mortality. The maternal-fetal prognosis was poor with 11.7% maternal deaths and 86.8% perinatal deaths. Conclusion: Better screening of populations at risk, quality ANC, early diagnosis and rapid and adequate management will improve the maternal-fetal prognosis.