Uterine ruptures in Yemen

To study the incidence, risk factors, clinical presentation, maternal morbidity and mortality, and perinatal mortality in cases with ruptured gravid uterus.

All cases with diagnosis of uterine rupture at Saudi Hospital at Hajjah, Yemen during 5-years period from April 1999 to March 2004 were studied. Detailed informations were obtained by reviewing hospital records.

Out of the total number of deliveries during the period (N=5547), 60 cases had uterine rupture giving a hospital incidence of one in 92 deliveries (1.1%). Forty-three cases (71.7%) with unscarred uterus and 17(28.3%) had a previous cesarean scar. Poor antenatal and intra-natal care were the main contributing factor (93.3% had no prenatal visit, 95% presented to the hospital late after long period of obstructed labor at home). Grand-multiparty was encountered in 69.8% of cases with unscarred uterus and 41.2% of cases with a previous scar (p<0.05). Associated factors in unscarred uterus cases included: cephalopelvic disproportion (39.5%), shoulder presentation (25.6%), oxytocin (14%), breech delivery (7%), hydrocephalus (7%), brow (2.3%), misoprostol induction of labor (2.3%), and previous surgical evacuation (2.3%). In previous cesarean scar cases, cephalopelvic disproportion affected 58.8%, and shoulder presentation 5.9%. The complete rupture was reported in 48 cases (80%), hysterectomy was carried out for 33 cases (55%), repair for 23 cases (38%), and repair plus bilateral tubal ligation for 4 cases (7%). Five cases (8.3%) needed additional surgical intervention in the form of repair of ruptured bladder (3 cases), and repair of bladder injury (2 cases). Vesico-vaginal fistula developed in 2 cases (3.3%). Fifty-three cases required blood transfusion (88%). Hospital stay ranged between 1-17 days (mean 6.2, SD 3.6). There was one maternal death (1.7%) and 49 (81.7%) perinatal deaths.

This study confirms high incidence of such serious preventable obstetrical problem. Poor antenatal and intranatal care, poor provision of health service and low socio-economic standard are the main factors contributing to uterine rupture.