Ruptured uterus-eight year retrospective analysis of causes and management outcome in Adigrat Hospital, Tigray Region, Ethiopia
AbstractBackground: Ruptured uterus is a common cause of maternal and perinatal mortality and morbidity. Further studies may help in the development of preventive strategies. Objective: To determine the frequency, cause and management outcome of ruptured uterus at a zonal hospital.
Method: A retrospective study (April 1, 1993-March 30, 2001) was done to describe the frequency, cause, treatment, complications, and maternal and fetal mortality associated with ruptured uterus. A structured questionnaire was used to collect information from delivery registration books, operation room records, and patient cards.
Result: A total of 54 cases of ruptured uterus and 5,980 hospital deliveries were recorded for a ratio of 1:110. Causes of rupture were: cephalopelvic disproportion (53.7%), malpresentation and malposition (25.9%), instrumental (3.7%), pitocin induced (3.7%), uterine scar (11.2%) and placenta percreta (1.8%). Most were multipara and rupture was complete in 94.4%. Site of rupture was in lower uterine segment in 58.5% and left lateral in 24.5%. Ten cases (18.5%) had associated bladder injury. Total abdominal hysterectomy was performed in 20 (37%), subtotal abdominal hysterectomy in 13 (24.2%) and repair in 21 (38.9%) cases. Vesicovaginal fistula and wound infection were common post-operative complications. Maternal case fatality rate was 11.1% and fetal case fatality rate was 98.1%. Ruptured uterus contributed 24% of all causes of maternal deaths in the hospital within the study period.
Conclusion: This calls for an integrated effort to prevent the causes of uterine rupture and ensure prompt management to reduce maternal and perinatal mortality and morbidity.
[Ethiop.J.Health Dev. 2002;16(3):241-245]