Prevalence and factors associated with management outcome of uterine rupture at wolliso saint luke catholic hospital, oromia regional state, southwest shoa Ethiopia

Abstract

INTRODUCTION: Uterine rupture is a life threatening obstetric complication of pregnancy. It is a major public health problem in developing countries. In Ethiopia maternal and perinatal mortality due to uterine rupture is very high. Thus studying the factors associated with management outcome of uterine rupture in our context is important to implement appropriate preventive measures as well as to give recommendation to relevant concerned bodies. OBJECTIVE: The objective of the study was to assess prevalence and factors associated with management outcome of uterine rupture at Wolisso Saint (St.) Luke Catholic Hospital. METHODS: Hospital based retrospective cross-sectional study was conducted at Wolisso St. Luke Catholic Hospital from January 1,2009 to December 31,2013 by reviewing medical records using a prepared checklist. Percentage was used to review the prevalence of uterine rupture and logistic regression was carried out to analyze the association between dependent and independent variables. P< 0.05 was considered as statistically significant. RESULT: The analysis revealed that 151 cases of uterine rupture among 14,152 deliveries, the prevalence being 1.07% during the study period. A total of 90 cases were analyzed. Majority (67.8%) was multigravids, 96.7% were from rural area, 63.3% had prolonged duration of labor and 53.3% were unbooked. The causes of uterine rupture were obstructed labor due to cephalopelvic disproportion (42.2%) and malpresentation/malposition (37.8%), previous cesarean scar (15.6%), instrumental deliveries (3.3%), and induction with pitocin (1.1%). Rupture after hospital admission observed in 13.3% of cases. Uterine repair with bilateral tubal ligation was performed in 40%, total abdominal hysterectomy in 26.7%, repair only in 24.4%, and subtotal abdominal hysterectomy in 8.9% of the cases. Forty five (50%) mothers developed postoperative complications. Of those anemia (33.3%) was the commonest. Fetal and maternal case fatality rate was 94.4% and 4.4% respectively. Women who presented with un-recordable blood pressure are 4.1 times more likely to have a bad maternal outcome than those who presented with recordable blood pressure [AOR=4.1; 95%CI (1.25-13.4), P-value=0.02]. Neonates born from mothers who had previous cesarean scar have 22.5 times more likely to be alive than those born from mothers who had no previous cesarean scar [AOR=22.5; 95%CI (1.91-266.36), Pvalue=0.013]. CONCLUSION AND RECOMMENDATION: The prevalence of uterine rupture is high with significant perinatal and maternal morbidity and mortality. The commonest underline cause was obstructed labor. The commonest surgical intervention was repair with bilateral tubal ligation. Blood pressure had significant association with maternal outcome. Previous cesarean scar had significant association with neonatal outcome. Therefore clinicians should detect early warning signs of uterine rupture, increase health service coverage and improve quality of service will improve uterine rupture related perinatal and maternal morbidity and mortality.