Abstract:

Background: Uterine rupture is one of the major obstetric complications which is associated with adverse fetal and maternal outcomes including severe hemorrhage, genital urinary injury, low Apgar scores, fetal and maternal death. There is a paucity of data about uterine rupture and its fetal-maternal consequences among pregnant women managed at BMC. As a result, it is difficult to know the magnitude of the problem and formulate appropriate measures to reduce its incidence and the complications associated with it. This study was thus conducted to determine the incidence, risk factors, fetal and maternal outcomes among women with uterine rupture at BMC, Mwanza-Tanzania.

Methodology: This was a 5-year (2013 to 2017) retrospective descriptive study of cases of uterine rupture at BMC. The case files were collected from medical records department and maternal demographic information, clinical presentation, risk factors, interventions and fetomaternal outcomes were extracted using a checklist. Data was analyzed using STATA software version 13.

Results: There were 37763 deliveries in the five years of the study. Caesarean section accounted for almost a quarter of these deliveries. During this period 81 cases of ruptured uterus were identified, making an incidence of 2.15 cases per 1000 deliveries. Common risk factors for uterine rupture seen in the studied cases were: history of previous caesarean section (54%), obstructed labor (37%), grandmultiparity (31%) and use of oxytocin (24%). Maternal case fatality rate in this study was 1.5%. More than half of the cases had hysterectomy while about a third had uterine repair without BTL. Over 80% of the cases required blood transfusion. Sepsis developed in 21% of the cases and VVF in 12%. Perinatal case fatality rate was 72%. Out of the 24 babies who were born alive, 37.5% had low Apgar scores and 56% died before discharge.

Conclusion: Uterine rupture at BMC is associated with high perinatal deaths and high rates of maternal adverse outcomes and need for blood transfusion but favorably low maternal case fatality rate. The leading risk factor for uterine rupture seen was previous caesarean scar and obstructed labor.

Recommendations: Improvement in monitoring of patients in labor at BMC and the referring centers is necessary to detect early features of uterine rupture and fetal compromise and to prevent obstructed labor. This will contribute to reduced incidence of uterine rupture and improve fetomaternal outcomes.