Research Article
Volume 10 Issue 10 - 2021
Prevalence, Causes and Surgical Outcomes in Women with Uterine Rupture at a Tertiary Hospital in Port-Harcourt, Nigeria - Lessons for Obstetric Care
Peter A Awoyesuku*, Dickson H John, Simeon C Amadi and Ngozi J Kwosah
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Old G.R.A, Port-Harcourt, Nigeria
*Corresponding Author: Peter A Awoyesuku, Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Old G.R.A, Port-Harcourt, Nigeria..
Received: July 26, 2021; Published: September 07, 2021




Abstract

Background: Uterine rupture (UR) is a life-threatening obstetric emergency often associated with grave maternal and fetal consequences. This unfortunate, mostly preventable event, although exceedingly rare in developed world, has remained a significant problem in developing nations.

Objective: This study sought to determine the prevalence and causes of UR, evaluate the surgical outcome, and assess the associated factors in women.

Methodology: This was a retrospective review of cases of UR managed between January 2016 and December 2020. Data were obtained from operating theater and labour ward records. Information on maternal age, parity, gestational age, booking status, education, cause of UR, type of surgery, cadre of surgeon, length of surgery, estimated blood loss and any blood transfusion, and mortality, were extracted. Data were analyzed using SPSS version 20. The Chi-square test or Fisher exact test and analysis of variance test were used for statistical analysis of non-continuous and continuous variables as appropriate and statistical significance was set at p < 0.05.

Results: During the five-year study period, there were 11,981 deliveries, of which 95 women were managed for UR, giving a prevalence of 0.8% or ratio of about 1:126 women. Most of the UR, 44 (46.3%), occurred in women with previous caesarean section scar in labour, followed by obstructed labour in 25 (26.3%). There was significant association between booking status and occurrence of UR (P = 0.003). Most of the women, 82 (86.3%), had repair of the uterus ± BTL, 9 (9.5%) had subtotal hysterectomy, while 4 (4.2%) had total hysterectomy. There was significant association between parity and type of surgery performed (P = 0.028) and cadre of surgeon with the mean estimated blood loss at surgery (P = 0.045). There were 5 maternal deaths, giving a rate of 5.3% or a case fatality of 1:19 women and 67 (70.5%) perinatal deaths, giving a perinatal mortality ratio of about 1:1.5 cases. There was significant association between maternal death and mean estimated blood loss (P = 0.016) and mean duration of surgery (P = 0.015), while perinatal death was significantly associated with mean estimated blood loss (P = 0.010) only.

Conclusion: The prevalence of UR of 1:126 in this study was high. Previous caesarean scar and lack of quality ANC (unbooked status) were significantly associated with UR. Most cases of UR had a repair without sterilization, and this was significantly associated with parity. The high maternal and perinatal mortality in this study was significantly associated with estimated blood loss.

Keywords: Uterine Rupture; Previous Caesarean Section; Obstructed Labour; Prolonged Labour; Obstetric Hysterectomy; Unbooked Mother

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Citation: Peter A Awoyesuku., et al. “Prevalence, Causes and Surgical Outcomes in Women with Uterine Rupture at a Tertiary Hospital in Port-Harcourt, Nigeria - Lessons for Obstetric Care”. EC Gynaecology 10.10 (2021): 03-14.

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