Ruptured uterus in rural Uganda: prevalence, predisposing factors and outcomes.

INTRODUCTION: A ruptured uterus is a life-threatening obstetric complication that remains a major public health concern in low-income countries, particularly in Africa. It is a significant cause of maternal and perinatal morbidity and mortality. In Uganda, the prevalence remains high largely because most women do not deliver in health facilities. Further review of this problem may be helpful in the development of appropriate preventive strategies.
METHODS: A five-year retrospective review of all cases of ruptured uterus admitted to Mityana Hospital, Uganda from January 1, 2003 to December 31, 2007 was conducted.
RESULTS: Out of 14,656 deliveries, 73 cases of ruptured uterus were recorded, resulting in a ratio of 1 in 200. The highest incidence was in patients aged 20-24 years old, of parity 1-4 and residing in the Kassanda sub-county. Other predisposing factors included not attending antenatal care (67.1 percent), which was associated with rupture at home or with traditional birth attendants (TBAs) (Odds Ratio [OR] 6.29; 95 percent confidence interval [CI] 2.01-19.67), obstructed or prolonged labour (68.5 percent), which increased the likelihood of rupture before admission (OR 3.28; 95 percent CI 1.05-10.26), residing more than 10 kilometres from the hospital (64.4 percent), which increased the likelihood of rupture before admission (OR 3.62; 95 percent CI 1.16-11.32) and the existence of previous scars (19.2 percent), which decreased the likelihood of rupture before admission (OR 0.24; 95 percent CI 0.07-0.81). All the women had surgery, of which 14 percent had a total hysterectomy, 22 percent had a subtotal hysterectomy, 25 percent had a repair and bilateral tubal ligation, and 39 percent had a repair only. Eight percent of the women died, while seven percent of the babies were born alive.
CONCLUSIONS: Uterine rupture is a disturbing problem in Uganda. There is a need to put in place a functional referral system for pregnant women that links the community and TBAs to the hospital, and a need to intensify information, education and communication programmes to encourage women and their partners to use the reproductive health services that are available to them. In addition, greater accessibility to equipped health facilities, the use of a partogram to monitor labour and timely interventions will go a long way to reducing uterine rupture.