Uterine rupture at a secondary hospital in Afikpo, Southeast Nigeria

Uterine rupture is an obstetric catastrophe that is associated with high maternal and perinatal mortality rates. Its incidence is high in developing countries. In Nigeria, the incidence of uterine rupture continues to increase due to poverty, illiteracy, ignorance, the lack of quality obstetric care and bad governance.

A retrospective review was conducted of all cases of ruptured uterus seen at the Mater Misericordiae Hospital in Afikpo, Nigeria between January 2001 and December 2007.

There were a total of 51 ruptured uteri out of 4,361 deliveries, yielding a ratio of one in 86. A total of 19 (37.3 percent) patients had a scarred uterus, while 32 (62.7 percent) had an intact uterus, yielding a scarred to unscarred uterus ratio of one in 1.7. The mean maternal age was 32.0 years, and the mean parity was 3.4. Patients with a scarred uterus had a lower mean age and parity. 29 (56.9 percent) cases were unbooked, out of which seven (24.1 percent) had a scarred uterus. Obstructed labour (88.2 percent), grandmultiparity (27.5 percent) and abnormal lie (9.8 percent) were the main causes of rupture. 39 (76.5 percent) patients had their labour managed at home or by traditional birth attendants before presentation. 45 (88.2 percent) patients underwent uterine repair alone, five (9.8 percent) had uterine repair with bilateral tubal ligation and one (two percent) had a hysterectomy. Three maternal deaths occurred, yielding a case fatality rate of 5.9 percent. The perinatal mortality rate was 84.6 percent.

Health education, the provision of quality obstetric care, improved governance and monitoring of the activities of traditional birth attendants may help to reduce the menace of uterine rupture.