Factors contributing to uterine rupture in women having vaginal births after caesarean section
AbstractContext: Ruptured gravid uterus is a common occurrence in our environment with higher risk in scarred uterus. Some women will attempt vaginal delivery at home after a caesarean section had been performed for cephalopelvic disproportion.
Objective: To evaluate the various reasons put forward by our women for attempting vaginal delivery at home despite previous caesarean section.
Subjects and Methods: Patients with ruptured gravid uterus during labour with history of previous caesarean section were studied using structured interview formats. Their demographic characteristics, social class, booking status, place of attempted vaginal delivery and various reasons for seeking unorthodox care. Close relative of patients were interviewed in unconscious or moribund patients.
Results: Some 24(96.0%) of the patient had no antenatal care in the index pregnancy and had laboured in spiritual churches or in traditional birth attendants homes. Ninteen (76.0%) were of low social class. Various reasons for attempting vaginal delivery at TBA's or spiritual churches included lack of funds 9(37.5%) husbands or close relative not available to take decision for hospital delivery 6(25.0%), not appreciating the need for hospital delivery 3(12.5%) and no reason 1(4.2%). There were 12 maternal deaths giving a case fatality rate of 48%.
Conclusion: The study shows socio economic factors, dependency on family decisions and belief in supernatural powers as major reasons our women chose unorthodox delivery despite prior caesarean section and recommend ways of preventing it.
Keywords: vaginal birth after caesarean section, uterine rupture
Tropical Journal of Obstetrics and Gynaecology Vol. 22(2) 2005: 177-179
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