Publication:

Patterns of uterine rupture in Nigeria: a comparative study of scarred and unscarred uterus

Background Study aims to explore the differences in presentation, management and outcome of uterine rupture among patients with and without previous uterine scar.

Methods A 5-year retrospective cross-sectional study of all cases of uterine rupture in Nigerian Christian Hospital. Data was analyzed using descriptive statistics, chi-square and logistics regression.

Results Incidence of uterine rupture was 14.6 per 1,000 live births (n=70; 40% unscarred uterus, 60% scarred uterus). Lateral rupture was more common with unscarred uterus (n=27; 39%) compared with anterior rupture in scarred uterus (n=43; 71%). Rupture of unscarred uterus often involved the cervix and vagina, while scarred uterus involved the bladder (P= 0.03). More cases with unscarred uterus resulted in hysterectomy (n=3; 14%) versus scarred uterus (n=2; 5%). Unscarred uterus was associated with more haemorrhage 771 (± 670) mL compared with 403 (±585) mL for scarred uterus (P= 0.02). Fetal survival was higher with scarred uterus (P= 0.04). There was no significant difference in the incidence of peri-operative complications between the groups.

Conclusion Rupture of scarred uterus was more common, while rupture of unscarred uterus was associated with more feto-maternal morbidity and mortality. Increase in caesarean section procedures in developing countries could increase the incidence of uterine rupture in these regions, thus prompting a need for improvement in obstetrics care.