Uterine ruptures: epidemiological aspects and prognosis at N’djamena Mother and Child Hospital

Abstract

Background: Uterine rupture is a non-surgical breach of the continuity of the myometrial wall, and is always a major obstetric emergency.

Objective: To identify the main etiologies of uterine rupture aiming to improve its management and reduce its morbidity.

Material and method: This was a prospective and descriptive survey carried out for nine months in 2013 at N’Djamena Mother and Child hospital The population studied was pregnant women (>28 gestational weeks), or in post-partum period, admitted for uterine rupture. Chi-square (X2) test (p<0.05) was used to compare variables

Result: We recorded 54 uterine ruptures among 9384 deliveries giving a frequency of 0.57%. The average age was 26. 8 years with a range of 15 to 40 years. Thirty two of the 54 patients (57.4%) were multiparous (average parity was 3.8). Eighteen had a scarred uterus (p=0,014). Among the causes, foeto pelvic disproportion was observed in44.4% of patients (n=24/54) followed by the inappropriate use of oxytocin in 24.1% (n=13/54). Complete uterine rupture was noted in 77.8%. Laparotomy was performed in all cases. The conservative treatment (suture of uterine lacerations) was done in 47cases (87%). Hysterectomy was carried out in 7 cases (13%). Five patients died (9.3%) in the intensive unit care. Fifty foetuses (92.6%) died.

Conclusion: Uterine rupture is an obstetrical emergency. It remains a common cause of death for the mothers and foetuses. The prevention is possible.

Keywords: uterine rupture, epidemiological aspects and foeto-maternal prognosis