Determinants of uterine rupture in South-South Nigeria: a 12-year analysis of clinical patterns and the impact of advanced maternal age

Abstract

Uterine rupture is rare but life-threatening, especially in Nigeria, where high parity, unbooked cases, and obstructed labour play major roles. This study evaluated patterns, risk factors, and maternal–fetal outcomes of uterine rupture over 12 years at Delta State University Teaching Hospital (DELSUTH), Oghara, Nigeria, through a retrospective review of 18 patients with complete records managed between January 1, 2014 and December 31, 2025 in the obstetric unit. We analyzed baseline characteristics, risk factors, intraoperative findings, management, and maternal–fetal outcomes. Associations with advanced maternal age (≥35 years) were assessed using Chi-square or Fisher's exact test; p < 0.05 was significant. During the study period, a total of 2,087 deliveries were recorded, among which 20 cases of uterine rupture were identified, giving an incidence of 0.96% (20/2,087 deliveries). Eighteen complete records were analyzed. Mean maternal age was 36.4 ± 5.1 years; mean gestational age, 37.9 ± 2.1 weeks. Most women were grand multiparous (50%), married (88.9%), and rural residents (83.3%). Over half were unbooked (55.6%), and 44.4% had a prior caesarean section. Prolonged (72.2%) and obstructed labour (66.7%) were leading risks. The lower uterine segment was the commonest rupture site (55.6%). Management included uterine repair with or without tubal ligation and hysterectomy; all patients received blood transfusions. Maternal complications included anaemia, infection, and sepsis, with one death. Fetal outcomes were poor (77.8% mortality). Advanced maternal age significantly associated with grand multiparity, rural residence, primary education, and married status (p < 0.05). In our setting, uterine rupture mainly affects older, multiparous, unbooked rural women. Leading causes include prolonged labour, obstructed labour, grand multiparity, and prior caesarean section. Maternal morbidity is high, and fetal mortality remains unacceptable. Better antenatal care, early complication detection, and timely surgery are essential to reduce the burden of uterine rupture in Delta State.