Trends, Determinants, and Perinatal Outcomes of Uterine Rupture: The Role of Three Delays at Nekemte Specialized Hospital, West Oromia, Ethiopia

Abstract

Uterine rupture is a life-threatening obstetric emergency characterized by the complete disruption of the uterine wall, including the endometrium, myometrium, and serosa. This condition poses significant risks to maternal and neonatal health, such as severe hemorrhage, infection, and perinatal death. The prevalence of uterine rupture is markedly higher in low- and middle-income countries due to limited access to quality maternal healthcare. In Ethiopia, facility-based studies indicate a prevalence of 1% to 5% in specialized hospitals, with uterine rupture contributing significantly to maternal mortality (10%-25%) and perinatal mortality rates exceeding 50%. Recognizing this public health concern, the study was conducted to understand the prevalence, determinants, and outcomes of uterine rupture at Nekemte Specialized Hospital, Oromia, Ethiopia, and to provide evidence for localized healthcare interventions. Methods A mixed-methods design was employed for this study. Quantitative data were collected retrospectively from hospital records spanning 2014 to 2022, analyzing trends, prevalence, and associated factors. Regression modeling was used to identify predictors of maternal and neonatal outcomes. Qualitative data were gathered through phenomenological interviews with twelve uterine rupture survivors and four key informants, exploring emotional, physical, and social impacts. Systematic random sampling was applied for the quantitative component, while purposeful sampling was used for the qualitative interviews. Quantitative data were analyzed using SPSS software, and qualitative data were thematically analyzed. Results The study revealed several significant findings. Over nine years, there was a gradual decline in uterine rupture prevalence, reflecting improvements in maternal healthcare services. Key determinants of uterine rupture included lack of antenatal care, high parity, rural residency, previous cesarean sections, and prolonged labor. Maternal outcomes highlighted high mortality rates caused by hemorrhage, uterine atony, and infections, with survivors often experiencing long- term complications such as anemia and infertility. Neonatal outcomes were equally severe, with xiii perinatal mortality exceeding 50%, primarily due to birth asphyxia and stillbirth. Premature delivery and low birth weight were identified as significant predictors of neonatal mortality. The study also examined the impact of the three-delay model. Cultural beliefs, financial barriers, and a lack of awareness influenced delays in seeking care. Delays in reaching care stemmed from geographical barriers, poor road infrastructure, and transportation challenges. Finally, delays in receiving adequate care were linked to shortages of trained healthcare personnel, inadequate emergency obstetric services, and inefficient referral systems. Women who survived uterine rupture shared their lived experiences, which included profound psychological, social, and economic challenges. Survivors reported experiencing post-traumatic stress disorder, anxiety, and depression. Cultural stigmatization and feelings of guilt exacerbated their psychological distress. Socially, survivors often faced marital discord, community ostracization, and financial hardships caused by medical expenses and loss of productivity. Despite these challenges, coping mechanisms such as family support, healthcare providers' assistance, and community organization engagement were instrumental in recovery. However, access to counseling and rehabilitation services was limited. Conclusions Uterine rupture remains a significant public health challenge in Ethiopia, particularly in resource- constrained settings. To address this, healthcare infrastructure should be improved through investments in emergency obstetric services, including training, deploying skilled birth attendants, and providing essential medical supplies. Strengthening referral systems by enhancing communication and transportation networks is also critical to reducing delays in accessing care. Community education campaigns are needed to raise awareness about the importance of early healthcare-seeking behavior and to address cultural stigmas surrounding maternal health. Additionally, psychosocial support programs, including counseling and rehabilitation services, should be established to address survivors' needs. Finally, region-specific policies must be developed to tackle disparities in maternal healthcare access and outcomes.