ABSTRACT

BACKGROUND:

Ruptured uterus is an obstetric emergency associated with high maternal and fetal mortality. The outcome is worsened in sub-Saharan Africa because of the delay in treatment. We aimed to evaluate uterine rupture cases and their outcome with respect to surgical choice”.

METHODS:

A 15 years retrospective re-appraisal of ruptured gravid uterus in a tertiary hospital, with emphasis on choice of surgical treatment and maternal outcome.

RESULTS:

During the study period 131 cases of ruptured uterus were recorded and 21,905 deliveries took place, giving a ratio of 1 rupture gravid uterus in every 167 deliveries. A significant percentage of the patients were non-literate (71%), unbooked for antenatal care (77.9%) and belonged to the low social class (58.8%). Types of rupture were mainly spontaneous rupture (64.1%), followed by scar rupture (26%) and 9.9% had traumatic uterine rupture. Of the 130 cases that had surgery, 110 (84.6%) had repair with or without tubal ligation and 20 (15.4%) had hysterectomy. Ninety-nine (90%) out of the 110 repair surgeries were done by resident doctors and 19 (95%) out of the 20 hysterectomies were done by the consultant staffs. Maternal mortality and morbidity were 25.2% and 94.9% respectively, mainly due to sepsis and anaemia. The maternal mortality and morbidity were significantly high in the repair group and was lowest in the group that had subtotal hysterectomy. Twenty eight (84.8%) of the total 33 maternal deaths occurred in the post-operative period.

CONCLUSION:

Sub-total hysterectomy seems to be a better surgical treatment for cases of ruptured uterus in resource poor settings like ours. Taking into consideration that most patients are unbooked for antenatal care and referred with established sepsis and anaemia.