Morbidity and mortality during delivery on a scarred uterus in the obstetric gynecology department EHS Batna, Algeria

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Introduction. The existence of a scar uterus is a risk factor for obstetric morbidity in subsequent pregnancies. The objective of this work was to evaluate the morbidity and mortality during delivery in a scar uterus in our department, in order to reduce it and improve the maternal and fetal prognosis. Methods. We conducted a descriptive, retrospective, single-center epidemiological study at the EHS mother-child Batna from January 1, 2018 to December 31, 2019, which involved women with a scar uterus of obstetric origin with a pregnancy age greater than 22 Weeks of amenorrhea. Results. During this period; 28407 women delivered in our department; of which 3002 were carriers of a scar uterus (10.56%). The overall complication rate was 6.10% regardless of the mode of delivery: Uterine rupture with 19 cases of dehiscence of the scar (0.63%) and 9 cases of complete uterine rupture (0.30%). 2.60% of women had delivery hemorrhage and 1.13% required transfusion. Hemostasis hysterectomy was necessary for 9 women (0.30%). We observed 7 cases of placenta accreta, a rate of 0.23%, the wounds of the surrounding organs were caused in 3 cases (0.17%), the iterative laparotomy was performed in 2 cases (0.11%). Cervical tears complicated 5 vaginal deliveries (0.36%). Infectious complications (endometritis, surgical site infection, deep abscesses, episiotomy suture infection) were encountered in 1.77% of cases (n=53). A delay in admission duration of more than 7 days was necessary for 1.17% of women (n=35). No maternal deaths were reported. On the fetal side, we counted 3000 live births of which 94.77% had an Apgar score at 5 minutes greater than or equal to 7. The neonatal mortality rate was 1.87%. Conclusion. Women with a scar uterus are more and more numerous; the prognosis of delivery on a scar uterus is burdened with numerous complications, the most important of which is uterine rupture. However, the maternal-fetal prognosis can be improved by good monitoring of pregnancy, a careful selection of candidates for vaginal delivery and a close monitoring of the uterine test.