Uterine Rupture: A Reappraisal of the Experience in a Tertiary Hospital in North Central Nigeria.

Abstract

Introduction: Rupture of the gravid uterus is a major life threatening obstetric emergency, which had remained a major public health problem in low resource countries of the world and in Africa in particular. Its occurrence is associated with a high incidence of feto-maternal morbidity and mortality which clearly unveils the poor obstetric care delivery and socioeconomic status in these countries. 

Objectives: This study was to reappraise the prevalence, aetiologic risk factors, complications and feto-maternal outcomes of uterine rupture at the Federal Medical Centre, Keffi, Nasarawa State, North- Central Nigeria.  

Materials and Methods: A retrospective study of pregnant women with ruptured uterus managed at the Department of Obstetrics and Gynaecology of Federal Medical Centre, Keffi, from 1st January 2020 to 31st December 2022. Information on the age, parity, booking status, aetiology, place of intrapartum care, maternal complications and feto-maternal outcomes were extracted and analyzed using SPSS 25 version and the result was presented as frequencies and percentages using simple statistical tables. 

Results:The total number of deliveries was 3,398 and those with ruptured uterus were 23, giving a prevalence of 0.68% or 1 in 148 deliveries. The mean age of the women was 30.32 ± 1.15 years. The highest prevalence was among unbooked multiparous women (90.91%). Major risk factors were prolonged injudicious oxytocin use (50.0%) in unscared uteri, obstructed labour (22.73%) and previous caesarean section scar (18.18%). Most of the ruptures were anteriorly sited (50.0%). Uterine Repair with bilateral tubal ligation was the commonest mode of treatment (50.0%), while hysterectomy was done (18.18%) for cases with extensive ruptures. The commonest complication was postoperative anaemia (36.36%). There were three maternal deaths, with a case fatality rate of 13.6%, while the perinatal mortality was 90.91%.

Conclusion: The prevalence of ruptured uterus is still high in our facility with grave maternal and perinatal morbidity and mortality. Regrettably this catastrophe is highly preventable through measures like increased antenatal utilization, planned delivery of at-risk patient executed by skilled birth attendants, good referral system with well equipped facilities. This quagmire can be reduced to the barest minimum.