Incidence,Risk Factors,Surgical Options,and Maternal and Perinatal Outcomes of Ruptured Uterus in Nnewi: A 10-Year Review

Abstract

Abstract

Objective: The aim of this work was to determine the incidence, risk factors, surgical options, and maternal and perinatal outcomes of ruptured uterus in Nnewi. Design: This was designed as a 10-year retrospective study of women managed at Nnamdi Azikiwe University Teaching Hospital (Nnewi, Nigeria) between January 1, 1999 and December 31, 2008 who had ruptured uterus. Methods: The theater and ward records and case notes of all women who had ruptured uterus from 1999 to 2008 were retrieved, and the incidence, risk factors, surgical options, and maternal and perinatal outcomes were retrieved and analyzed. Epi Info™ 5.1 was used in the analysis. Results: A total of 54 patients had uterine rupture during the study period. However, only 48 cases were analyzed. Six case notes were not seen in the records department. During the study period, the total number of deliveries was 8042, giving a prevalence of 6.7/1000 or 1 in 149 deliveries. The number of unbooked patients (i.e., not evaluated in the antenatal period before presentation with complications in labor) was 42 (87.5%). Thirty-nine (81.5%) patients had a previous uterine scar. The most common predisposing factors were presence of uterine scar, use of oxytoxics alone, and the use of oxytoxics in a previous scar. The total mortality rate was 18.8% and the fetal mortality rate was 87.5%. The most common cause of maternal morbidity was anemia 27(56.3%). Conclusions: The predisposing factors for uterine rupture in Nnewi are modifiable, and case fatality is high. Integrated efforts to prevent occurrence and ensure prompt management to reduce maternal and fetal mortality are needed. (J GYNECOL SURG 28:13)