Uterine ruptures in Yemen.

Abstract

OBJECTIVE:

To study the incidence, risk factors, clinical presentation, maternal morbidity and mortality, and perinatal mortality in cases with ruptured gravid uterus.

METHODS:

All cases with diagnosis of uterine rupture at Saudi Hospital at Hajjah, Yemen during 5-years period from April 1999 to March 2004 were studied. Detailed informations were obtained by reviewing hospital records.

RESULTS:

Out of the total number of deliveries during the period (N=5547), 60 cases had uterine rupture giving a hospital incidence of one in 92 deliveries (1.1%). Forty-three cases (71.7%) with unscarred uterus and 17(28.3%) had a previous cesarean scar. Poor antenatal and intra-natal care were the main contributing factor (93.3% had no prenatal visit, 95% presented to the hospital late after long period of obstructed labor at home). Grand-multiparty was encountered in 69.8% of cases with unscarred uterus and 41.2% of cases with a previous scar (p<0.05). Associated factors in unscarred uterus cases included: cephalopelvic disproportion (39.5%), shoulder presentation (25.6%), oxytocin (14%), breech delivery (7%), hydrocephalus (7%), brow (2.3%), misoprostol induction of labor (2.3%), and previous surgical evacuation (2.3%). In previous cesarean scar cases, cephalopelvic disproportion affected 58.8%, and shoulder presentation 5.9%. The complete rupture was reported in 48 cases (80%), hysterectomy was carried out for 33 cases (55%), repair for 23 cases (38%), and repair plus bilateral tubal ligation for 4 cases (7%). Five cases (8.3%) needed additional surgical intervention in the form of repair of ruptured bladder (3 cases), and repair of bladder injury (2 cases). Vesico-vaginal fistula developed in 2 cases (3.3%). Fifty-three cases required blood transfusion (88%). Hospital stay ranged between 1-17 days (mean 6.2, SD 3.6). There was one maternal death (1.7%) and 49 (81.7%) perinatal deaths.

CONCLUSION:

This study confirms high incidence of such serious preventable obstetrical problem. Poor antenatal and intranatal care, poor provision of health service and low socio-economic standard are the main factors contributing to uterine rupture.

• Authors: Abdalla E Diab
• Journal: Saudi medical journal (Saudi Med J) Vol. 26 Issue 2 Pg. 264-9 (Feb 2005) ISSN: 0379-5284 [Print] Saudi Arabia
• PMID: 15770303 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Female
• Gravidity
• Humans
• Incidence
• Maternal Mortality
• Middle Aged
• Obstetric Labor Complications
• Perinatal Care
• Pregnancy
• Pregnancy Outcome
• Prenatal Care
• Retrospective Studies
• Uterine Rupture (epidemiology, etiology)
• Yemen (epidemiology)