Uterine rupture; An obstetric tragedy still with us. A six year review of cases in a specialist hospital, NorthWest Nigeria

Uterine rupture is a major cause of perinatal and maternal morbidity and mortality, it usually has a devastating outcome if not promptly attended to. The study determined the trends, risk factors, feto-maternal outcomes following uterine rupture as seen at ASYBSH. Method: The study was a retrospective review of cases of uterine rupture managed at the ASYBSH between March 2015 and February 2021. Records of the theatre and labour wards were searched and the folders of patients with uterine rupture were retrieved. Relevant information such as socio-demographic variables, booking status, clinical presentations were retrieved and entered into a structured profoma. Results: Deliveries in the hospital during the period were eleven thousand four hundred and twenty (11,420), out of which one hundred and fifty-six (156) were complicated by uterine rupture giving an overall incidence of 1.36 percent or one in every seventy-four (74) deliveries. Uterine rupture occurred mainly among women of low socio-economic status and high parity. The major predisposing factors were injudicious use of oxytocin (62.8%) prolonged obstructed labour (19.8%), previous caesarean section scar (8.5%), use of misoprostol (5.3%), fundal pressure (2.4%) and unexplained factors (1.2%) Conclusion: Uterine rupture remains a devastating obstetric calamity with a high incidence. Injudicious use of oxytocin, prolonged obstructed labour and previous caesarean section scar were the three leading predisposing factors identified in this study

Facteurs de risque et prise en charge de la rupture utérine dans une structure de 1ere référence du Mali: cas du district sanitaire de Bougouni / Risk factors and management of uterine rupture in a 1st reference structure in Mali: case of the Bougouni health district

L'objectif était d'évaluer les facteurs de risque de la RU et de proposer les aspects thérapeutiques. Matériels et méthodes : Nous avons réalisé une étude cas-témoins au centre de santé de Référence de Bougouni en 2019. Résultats : De janvier au 31 décembre 2019; sur 1161 accouchements 43 RU ont été enregistrées soit 3,7% correspondant à une RU pour 27 accouchements. Les patientes de 35 ans et plus ont été plus touchée par la RU (44,2%) avec ORaIC95%= 6,3 [1,5 - 26,3]. Les évacuations obstétricales avaient un ORaIC95%=25,6 [7,8- 83,7]. La totalité des patientes étaient des femmes au foyer (97,7%) des cas versus (82,3%) des témoins avec ORaIC95%= 8,9 (1,1-69). Les Paucipares et multipares avaient respectivement un ORaIC95%= 6,2 [1,8 - 20,3] et 4,1[1,3 - 12,9]. La cicatrice utérine (20,9%) des cas contre 8,1 % les témoins avait un ORaIC95%= 2,9 [1,1 - 8,7]. En effet l'absence de CPN étaient un facteur de risque, ORaIC95%= 3,0 [1,3 ­ 6,9]. Le délai de la RU était ˂ 6 heures chez 95%. En effet 34 RU complètes (79,1%) et 9 RU incomplètes (20,9%) ont été notées. Seulement 2,3 % des cas avaient accouché par voie basse. Le traitement de la RU reposait sur la chirurgie (100%) complétée par celui du choc (51,2%) des cas et de l'infection (100%) des cas. Conclusion: La RU est fréquente dans nos pays sous médicalisés. Sa prévention efficace passe par des stratégies visant à agir sur les facteurs de risque

The objective was to assess the risk factors for and to suggest therapeutic aspects. Materials and methods: We carried out a case-control study at the Bougouni Reference health center in 2019. Results: From January to December 31, 2019; out of 1161 deliveries, 43 uterine rupture were recorded, 3.7% corresponding to one uterine rupture for 27 deliveries. Patients 35 years and older were more affected by uterine rupture (44.2%) with ORaIC95% = 6.3 [1.5 - 26.3]. Obstetric evacuations had an ORaIC95% = 25.6 [7.8-83.7]. All of the patients were housewives (97.7%) versus (82.3%) controls with ORaIC95% = 8.9 (1.1-69). Pauciparous and multiparous had an ORaIC95% = 6.2 [1.8 - 20.3] and 4.1 [1.3 - 12.9], respectively. The uterine scar (20.9%) of cases versus 8.1% of controls had a 95% ORaIC95% = 2.9 [1.1 - 8.7]. Indeed the absence of ANC was a risk factor, ORaIC95% = 3.0 [1.3 - 6.9]. The time to uterine rupture was ˂ 6 hours in 95%. In fact 34 complete uterine rupture (79.1%) and 9 incomplete uterine rupture (20.9) were noted. Only 2.3% of cases gave birth vaginally. Treatment of uterine rupture was based on surgery (100%) supplemented by shock (51.2%) of cases and infection (100%) of cases. Conclusion: Uterine rupture is common in our countries under medical care. Its effective prevention involves strategies aimed at acting on risk factors.

A seven-year review of emergency obstetric hysterectomy in a Nigerian tertiary institution

Background:Extirpativeuterinesurgeries for near-miss events are usually thelast resort when other conservative measures fail.Emergency obstetric hysterectomy(EOH)may still have a significant role where there are limited options.Objectives:To determine the prevalenceof EOH, theassociatedfactorsandthe foeto-maternal outcomeat the Olabisi Onabanjo University Teaching Hospital, Nigeria.Methods:This was a retrospective observational study covering sevenyears (January 2010 to December 2016). The case records of patients who hadEOH during this period were retrieved for data extraction. Results:There were 5,608 deliveries and 31 cases requiringEOH giving aprevalence rateof31/5,608(0.55%). The mean age of the patients was 30.3±4.2years, whilethe mean gestational age at delivery was 36.3±5.1 weeks. Most of thepatients16/25(64.0%) were of higher parity (>3), and12/25(48%)of the patients were within the age bracket of 25-34 years. Subtotal hysterectomywas the most common procedure(18; 72.0%), andruptured uterus wasthe main indication for EOH (40.0%). The twomost common interventions that were critical to survival includedmassive blood transfusion (24.0%)andIntensive Care Unit admission (20%).Two (8%)maternal deathsand 58.3% perinatal mortality wererecorded.Conclusion:EOH is still relatively frequently performedat this centredue tothehigh incidence of a ruptured uterus. Effortsshould be made to increase the proportion of deliveries attended by skilled personnel and improvethe capacity of lower levelhospitals for comprehensive emergency obstetric care

Peri-mortem laparotomy in a patient with a ruptured intra-abdominal pregnancy

Introduction :Intra-abdominal pregnancies can present at an advanced stage of pregnancy and can have the potential for life-threatening rupture and haemorrhage. The purpose of this case report was to discuss the early recognition and prompt management options of a patient with a life threatening ruptured intra-abdominal pregnancy.Case report:We report what we believe to be the first case of a patient who presented with an intra-abdominal pregnancy who underwent a peri-mortem laparotomy in the Emergency Centre following a cardiac arrest; and who exhibited a return to spontaneous circulation (ROSC).Conclusion: Peri-mortem laparotomy/thoracotomy coupled with high quality CPR and resuscitation may be lifesaving in a patient with a life threatening ruptured intra-abdominal pregnancy

Emergency Peripartum Hysterectomies at Muhimbili National Hospital; Tanzania: A Review of Cases from 2003 to 2007

Abstract:A retrospective review of all cases of emergency peripartum hysterectomy performed between January 1; 2003 and December 31; 2007 at Muhimbili National Hospital was done to determine the incidence; indications and complications; background characteristics; antenatal care attendance; referral status; and maternal and foetal outcomes. There were 55;152 deliveries during the study period and 165 cases of emergency peripartum hysterectomy; giving the incidence of emergency peripartum hysterectomy of 3 per 1000 deliveries. The main indication was uterine rupture (79) followed by severe post-partum haemorrhage due to uterine atony (12.7). The case fatality rate was 10.3 where as perinatal mortality rate was 7.7 per 1000 deliveries. The common complication identified intraoperatively was severe haemorrhage which accounted for 39.4 where as intensive care unit admissions (14.4) and febrile morbidity (12.4) were common after the operation. Blood was ordered in all cases but in 31 cases it was indicated that it was not available. Seventy nine patients received blood transfusion with the maximum number of units given to one patient being eight. Twenty two patients were given fresh frozen plasma (FFP); the median number of units given was two (range = 1- 6). In conclusion; emergency peripartum hysterectomy is a life saving procedure and very common at MNH. The most common indication was ruptured uterus followed by severe postpartum haemorrhage. More than half of the patients underwent emergency peripartum hysterectomy were referred from other health facilities with ruptured or suspected ruptured uterus. The procedure was associated with unacceptably high maternal and perinatal morbidity and mortality

Emergency Obstetric Hysterectomy in a Tertiary Hospital in Sokoto; Nigeria

Emergency obstetric hysterectomy (EOH) is a life-saving procedure which is often performed to treat some obstetric complications; as a last resort; to prevent maternal mortality. Objectives: This study was designed to determine the rate; indications; and complications of the EOH procedure at Usmanu Danfodito University Teaching Hospital (UDUTH); Sokoto. Materials and Methods: This retrospective study involved all the patients who had EOH at UDUTH; Sokoto; Nigeria; between January 2005 and December 2010. The case records of these patients were retrieved from the medical record library and information relating to age; parity; booking status; indications; type of hysterectomy; cadre of the surgeon; type of anesthesia; and complications of the procedure were extracted. The data were processed via SPSS version 11.5 and the ?2 test was used to analyze some of the results with the confidence limit set at 95. Results: During the 6-year period; 83 EOH were performed out of 16;249 deliveries giving the rate of the former as 0.51; i.e. 1 in 196 deliveries. However; the case records of only 74 patients (82.9) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2) were unbooked for antenatal care; and the rate of the procedure among these patients (1.82) was significantly higher than 0.07observed amongst booked subjects (P0.001). The main indication for the procedure was ruptured uterus (93.2) and the majority of the patients (95.9) had subtotal hysterectomy. Anemia (66.2); excessive hemorrhage (35.5); septicemia (18.9); and wound infection (16.2) were the leading complications. Excessive hemorrhage was significantly higher in the procedure performed by the senior registrars (51.2) compared to those undertaken by consultants (16.2); P

Les hysterectomies obstetricales realisees au service de Maternite du CHU de Toamasina Madagascar

Objectif: Decrire les facteurs de risque; les indications; les types d'hysterectomie realises et leurs complications rencontrees. Methodes: Il s'agit d'une etude retrospective des hysterectomies obstetricales realisees dans le service de Maternite du Centre Hospitalier Universitaire de Toamasina sur une periode de cinq ans; du 1er janvier 2005 au 31 decembre 2009. Resultats: Vingt-six cas d'hysterectomie obstetricale ont ete realises sur un nombre total de 13978 accouchements soit une frequence de 0;19. Les femmes les plus a risque etaient surtout celles agees entre 20 et 35ans (Odds Ratio = 12;27 ; IC a 95= 2;91 - 51;76; p=0;001) et les grandes multipares (Odds Ratio = 8;94 ; IC a 95= 2;14 - 37;32 ; p=0;001). La presence de suivi prenatal etait associee a un risque moindre (Odds Ratio = 0;2 ; IC a 95= 0;06 - 0;65 ; p=0; 01). L'indication etait dominee par les ruptures uterines (69) et les hemorragies de la delivrance (19). Une hysterectomie subtotale interannexielle a ete realise dans 81des cas. Les complications etaient surtout l'etat de choc (73); les infections (19); et les fistules vesico-vaginales (11;5). Le taux de mortalite maternel et foetal etait eleves; respectivement de 7;69et 81. Conclusion: Une meilleure prise en charge de la grossesse et de l'accouchement permettra de reduire les indications de l'hysterectomie obstetricale. D'autres techniques chirurgicales alternatives meritent d'etre largement diffusees

Audit of cases with uterine rupture: a process indicator of quality of obstetric care in Angola

Audit of uterine rupture (UR) used as a process indicator, can identify factors considered avoidable to improve future quality of obstetric care. Records of UR cases at a referral maternity in Luanda were studied retrospectively (n=43) and prospectively (n=67) including basic obstetric information, maternal and foetal outcome, duration of labour, time interval between diagnosis and intervention, drugs used, type of delivery and intervention, surgical procedures and complications. A clinical estimation of avoidability was based on this information. Prevalence of UR was 4.9%. Maternal case fatality rate was 14% and early perinatal mortality 71%. Women with previous Caesarean Section (CS) constituted 28%, grand multiparous women 44% and primiparous women 6%. Uterotonic treatment was given in 36%. Avoidability was estimated to 65%. Regular morbidity-oriented audits with analysis of clinical manage-ment reveal weaknesses in obstetric care and may serve as an instrument for future improvement (Afr. J. Reprod. Health 2010; 14[2]:55-62)

Les ruptures uterines au cours du travail; observees au CHUA/GOB Antananarivo Madagascar

La rupture uterine; urgence obstetricale majeure; a fait l'objet d'une etude retrospective au niveau du Centre Hospitalier Universitaire d'Antananarivo; Gynecologie-Obstetrique de Befelatanana (CHUA/GOB) en 2006.Trente-six ont ete enregistres sur 7152 accouchements; soit une rupture pour 199 accouchements. Le profil moyen est celui d'une femme agee de 25 ans a 36 ans (n=20 ; 55;5); multipare (n=22 ; 61;1) et habitant en zone rurale (n=25 ; 69;4). La plupart des gestantes n'ont pas beneficie d'une consultation prenatale reguliere (n=26 ; 72;2). La suture uterine a ete realisee dans 60;9des cas (n=23). Le pronostic etait marque par une mortalite prenatale tres elevee

Pronostic de la rupture utérine au cours du travail : à propos de 293 cas colligés au CHU de Bouaké (Cote d'Ivoire)

L'objectif a été de préciser la fréquence de la rupture utérine au sein de la maternité du CHU de Bouaké et de déterminer le pronostic en fonction de l'éloignement du CHU de Bouaké. Il s'agit d'une étude rétrospective et comparat ive qui s'est déroulée du 1er janvier 1996 au 31 décembre 2001. Cette étude a comparé les caractéristiques et le pronostic materno-fœtal de deux types de patientes : celles issues d'un périmètre de sécurité sanitaire arbitraire défini de 100 kilomètres autour de la ville et celles issues de localités situées au-delà. La fréquence de la rupture utérine a été de 2,44 % soit une rupture utérine pour 41 accouchements. L'hystérectomie a été plus pratiquée dans la population des femmes issues de localités situées au-delà du p é ri m è t re de sécurité sanitaire : 83,34 % contre 28,57 % (p < 10- 4). La létalité de la ru p t u re utérine a été de 11,26 % pour l'ensemble des patientes avec une surmortalité pour celles venues de localités au-delà du périmètre de sécurité sanitaire : 29,91% c o n t re 8,97 % pour celles du péri m è t re de sécurité sanitaire (p = 0,0052). La mortalité fœtale a été de 100 % pour les patientes hors du périmètre de sécurité sanitaire. Les patientes présentant une rupture utérine et évacuées de localités situées au-delà du périmètre sécurité sanitaire ont un pronostic materno-fœtal beaucoup plus sombre

Ruptures utérines à la maternité du Centre Hospitalier National Yalgado Ouedraogo (CHN-YO): Aspects épidémiologiques et cliniques

Une étude rétrospective sur 10 ans (du 1er janvier 1980au 31 décembre 1989) à la maternité du Centre Hospi-talier National Yalgado Ouédraogo à partir de 369 dos-siers cliniques a montré que les ruptures utérines re s -tent fréquentes avec une rupture utérine pour 76 accou-chements. Cette affection intéresse les femmes jeunesavec un maximum entre 21 et 30 ans.Dans les antécédents de ces patientes il faut retenir lamulti-parité, les césariennes antérieures et le non suivides grossesses

Faut-il une ligature tubaire systematique apres la troisieme cesarienne au Zaire?

Dans l'etiologie des ruptures uterines spontanees; l'existence d'une cicatrice uterine occupe une place preponderante: cesariennes iteratives segmentaires ou corporeales; curetages repetes et myomectomies. De symptomatologie souvent bruyante; ces ruptures uterines entrenaient presque toujours la mort foetale et constituent une cause non negligeagle de mortalite maternelle au Zaire

Blunt traumatic rupture of the pregnant uterus

A young Nigerian woman aged about 28 years was brought to the emergency department following a road traffic accident. Clinical examination revealed a state of severe shock with massive intraperitoneal haemorrhage following blunt abdominal trauma. Subsequent laparotomy revealed ruptured gravid uterus and extrusion of foetal parts. The case is presented because rupture of the gravid uterus following; penetrating injuries (other than deliberate abortions) is reportedly rare; while rupture from blunt trauma is even rarer