Ruptured uterus: five years retrospective analysis of the causes, complications and fetal-maternal in dar es salaam

Abstract

Background: Rupture of a gravid uterus is a serious complication that is associated with a high maternal and perinatal morbidity and mortality. At Muhimbili National hospital, there is a high incidence of ruptured uterus as well as the associated maternal and perinatal mortality. Reduction of the frequency of this obstetric emergency and its associated complications requires a collaborative effort between Muhimbili National Hospital and referring hospitals as well as availability of medical supplies and skilled personnel of all cadres. Objectives: To determine the incidence, causes, complications and fetal/maternal outcome among women with the diagnosis of ruptured uterus at Muhimbili National Hospital in Dar es salaam, Tanzania Method: This was a retrospective study. Case notes (from 2003 to 2007) of patients with the diagnosis of ruptured uterus were retrieved and a structured checklist was used to collect patients' information. This was supplemented by information from midwifery books and operation/theatre records. Results: There were 55152 deliveries between 2003 and 2007 of which about 30% were delivered by caesarean section. A total of 162 cases of ruptured uterus were recorded in five years studied. However, only 123 (76%) case notes were available for analysis. Most of the uterine ruptures occurred due to neglected obstructed labor (37.8%) and previous caesarean section scar 33.6%. Other causes were: use of misoprostol alone 8.9%, use of oxytocin 7.3%, a combination of misoprostol and oxytocin 11.4%, previous repair of uterine rupture 2.8% and previous myomectomy 2.1 %. Majority of uterine ruptures occurred in women in their second to fourth parity (80%) and ruptures were complete in 78%. Associated complications of ruptured uterus or surgery were vesicle vaginal fistula, ureter injuries, rectovaginal fistula and urinary bladder injury and sepsis was found to be the commonest complication occurring in 14.8%. Subtotal abdominal hysterectomy was the most common surgical intervention (82%).Rent repair and sterilization (Bilateral tubal ligation) was done in 19.5% of cases, and repair only in 11.4%.Total abdominal hysterectomy was the least commonly done operation, (2.4%). Maternal case fatality rate was 12.2% and fetal case fatality rate was 97.6%. Ruptured uterus contributed to 9.2% of all causes of maternal deaths at Muhimbili national Hospital between 2003 and 2007. Majority (82.1 %) of patients in this study were referred from other health facilities and 15% of all cases of ruptured uterus the diagnosis was made in the referring facilities. Conclusion: The incidence of ruptured uterus at Muhimbili National Hospital is high and contributes significantly to both maternal and fetal morbidities and mortalities. The leading causes being obstructed labor, previous caesarean sections sacra and use of uterotonic drugs for induction and/or augmentation of labor. Others were previously ruptured uterus and myomectomy scars. Most of these patients were referred from municipal hospitals in dare s salaam and coastal regions. Proper monitoring of labor both in these referring facilities and at MNH will contribute to the reduction of these morbidities and mortalities.

/