Abstract
Introduction: Uterine rupture is a complete or incomplete non-surgical continuity solution of the wall of the gravid uterus. Indeed, it is a Affection obstetrical condition whose maternal-fetal prognosis is poor in terms of morbidity and mortality. Objectives: To assess the risk factors for uterine rupture in the Koutiala Health District. Methods: This was a descriptive and analytical cross-sectional prospective collection study from January 1, 2019 to December 31, 2019, a 12-month period. In our study, all patients admitted to the maternity ward were included during the study period for which the diagnosis of uterine rupture was made. Results: Out of a total of deliveries, we recorded 27 cases of uterine rupture, a frequency of 1.04%. The average age of our patients was 32 years with extremes of 19 and 45 years. We notice 92.6% of uterine ruptures during the transfer. Almost 3/4 of our parturients were out of school 70.4% versus 11.1% in primary school and 18.5% in secondary school. The majority of patients affected by uterine rupture came from rural areas 85.2%. Only 14.8% were from Koutiala city. The admission time to the Koutiala Reference Health Centre was 2 hours 30 minutes in 50.85% of our patients with extremes of 15 minutes and 4 hours 30 min. The average parity was 6.30 - 3036; large multiparous accounted for 63% in our sample followed by multiparous 18.5%. As for pregnancy follow-up, 100% of the patients had not performed any prenatal consultations. In 85.2% hysterrhaphy was performed intervention and hysterectomy in 14.8%. Maternal prognosis was satisfactory in 96.30% of cases. From the point of view of morbidity: 1 case of bladder-vaginal fistula was recorded and corrected by the bladder survey at home for 15 days. Late complications were the occurrence of anemia in 16 patients who were transfused and 1 case of phlebitis. We recorded 1 maternal death and 25 stillbirths. Conclusion: Uterine rupture is one of the leading causes of maternal and fetal mortality in Mali.
Highlights
Uterine rupture is a complete or incomplete non-surgical continuity solution of the wall of the gravid uterus
The majority of patients affected by uterine rupture came from rural areas 85.2%
The admission time to the Koutiala Reference Health Centre was 2 hours 30 minutes in 50.85% of our patients with extremes of 15 minutes and 4 hours 30 min
Summary
Uterine rupture is a complete or incomplete non-surgical continuity solution of the wall of the gravid uterus. From the base to the top, we have: First Level (I): CSCOM (Community Health Centre without operating theatre for pregnancy follow-ups and deliveries) and a dispensary; Second Level (II): CSRéf (Reference Health Centre with an operating theatre for dystocia deliveries and follow-up of pathological pregnancies); Third Level (III): Regional Hospitals; Fourth Level (IV): University Hospitals (CHU) This system includes: failures in health infrastructure that are insufficient and far from the reference health centre and a centre with an operating theatre to perform caesarean sections in an emergency; poor road infrastructure resulting in a delay in evacuation and inadequacies in telecommunications as some areas with health centers are not covered by telephone networks or the network signal is bad.
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