Uterine rupture: a retrospective analysis of causes, complications and management outcomes at Muhimbili National Hospital in Dar es Salaam, Tanzania|
KIDANTO, HUSSEIN L.; MWAMPAGATWA, IPYANA & VAN ROOSMALEN, JOS
Rupture of the gravid uterus is an obstetric catastrophe that is associated with
complications that include massive blood loss, hysterectomy, and damage to the genitourinary tract.
It is a serious complication that is associated with high maternal and perinatal morbidity and
mortality. We conducted a retrospective review of case notes (from 2003 to 2009) to determine the
incidence, causes, complications and foetal/maternal outcome among women with a diagnosis of
ruptured uterus at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania. Case notes with
diagnosis of ruptured uterus were retrieved from the records department and information on
maternal demographic characteristics, surgical intervention, maternal and perinatal outcome were
collected using a check list. Where information was inadequate it was sought from the obstetric
database. Obtained data was cleaned and analyzed using PASW statistics 18 software. Out of 72,570
deliveries 163 cases of ruptured uterus were recorded in seven years, making an incidence of 2.25 per
1000 births. Most ruptures (38%) resulted from neglected obstructed labour and scared uterus (33.6%).
Major obstetric haemorrhage (>1500 ml) was the most frequently encountered complication followed
by sepsis. Subtotal hysterectomy was the most common (73.6%) surgical intervention. Maternal and
perinatal case fatality rates were 12.9%, and 96.3% respectively. Ruptured uterus contributed to 6.6%
of all maternal deaths. These findings underscores the need for proper monitoring of labour both in
the referring facilities and at MNH and improvement of comprehensive emergence obstetric care at
all levels of health care to avoid unnecessary delays in care.
obstructed labour; uterine rupture; hysterectomy; maternal mortality; Tanzania