Rupture of unscarred uterus: a multi-year cross-sectional study from Nigerian Christian Hospital, Nigeria

Kelechi N. Eguzo, Chisara C. Umezurike

Abstract


Background: Rupture of the gravid uterus is a known catastrophic event in obstetrics. Rare in developed countries, it contributes to the high maternal mortality in developing countries like Nigeria. Little is known about the determinants of rupture in unscarred uterus, especially in Nigeria, unlike rupture of scarred uterus. This paper studied the factors associated with rupture of unscarred uterus in Nigerian Christian Hospital.

Methods: This was a multi-year, cross-sectional descriptive study of all cases of primary uterine rupture in the hospital between May 2002 and October 2007. Key factors studied include demographics, place of initial presentation in labour, use of uterotonics, duration of labour, maternal and fetal outcome, injury to structures adjacent to the uterus as well as type of surgical intervention.

Results: Rupture of unscarred uterus comprised 40% (n=28) of rupture in the study period, with incidence of 8.4 per 1,000 births in the hospital. Most cases aged 25-34 years with parity of 3 or above. A significant proportion of cases were first managed by Traditional Birth Attendants (p=0.01, α=0.05), and there was statistically significant association between prolonged labour and initial presentation to TBAs (χ2 =16.44, P<0.001, α=0.05). Contiguous injuries to the cervix/vagina were most common among the cases. The associated maternal and perinatal mortality rates were 14% and 93% respectively.

Conclusion: Primary uterine rupture was found to be associated with high parity and prolonged labour. Initial management by TBAs (with associated prolongation of labour) was strongly correlated to the occurrence of this event. It is recommended that health policy makers emphasize the deployment of competent health workers with obstetrics training in rural areas, to replace the traditional birth attendants.


Keywords


Nigeria, Traditional birth attendants, Uterine rupture

Full Text:

PDF

References


Okafor UV, Aniebue U. Anaesthesia for uterine rupture in a Nigerian teaching hospital: maternal and fetal outcome. International Journal of Obstetric Anesthesia (2006) 15, 124–128.

WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture, BJOG: an International Journal of Obstetrics and Gynaecology September 2005, Vol. 112, pp. 1221–1228.

Eze JN, Ibekwe PC. Uterine rupture at a secondary hospitalin Afikpo, Southeast Nigeria, Singapore Med J 2010; 51(6):506.

Kaczmarczyk M, Spare´n P, Terry P, Cnattingius S. Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population-based study of successive pregnancies in Sweden. BJOG 2007;114:1208–1214.

Zwart J, Richters J, O¨ ry F, de Vries J, Bloemenkamp K, van Roosmalen J. Uterine rupture in the Netherlands: a nationwide population-based cohort study. BJOG 2009;116:1069–1080.

Manoharan M, Wuntakal R, Erskine K. Uterine rupture: a revisit The Obstetrician & Gynaecologist 2010;12:223–230.

Ezegwui HU and Nwogu-Ikojo EE. Trends in uterine rupture in Enugu, Nigeria. Journal of Obstetrics and Gynaecology, April 2005; 25(3): 260-262.

World Health Organization. Traditional birth attendants: a joint WHO/UNICEF/UNFPA statement. Geneva: World Health Organization, 1992.

Ofili AN and Okojie OH. Assessment of the role of traditional birth attendants in maternal health care in Oredo Local Government Area, Edo State, Nigeria. Journal of Community Medicine and Primary Health Care. June 2005;17(1):55-60.

Sibley LM, Sipe TA, Brown CM, Diallo MM, McNatt K, Habarta N. Traditional birth attendant training for improving health behaviours and pregnancy outcomes. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.:CD005460. DOI: 10.1002/14651858.CD005460.pub2.

National Population Commission (NPC) [Nigeria] and ICF Macro. Nigeria Demographic and Health Survey2008. Abuja, 2009 http://www.measuredhs. com/pubs/pdf/OF12/OF12.SE.5.english.pdf.