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Rupture of the uterus: a review of 32 cases in a general hospital in Zambia

1996; BMJ; Volume: 312; Issue: 7040 Linguagem: Inglês

10.1136/bmj.312.7040.1204

0959-8138

M. Nkata,

Grief, Bereavement, and Mental Health

During July 1993 to June 1994, in Zambia, 32 pregnant women aged 15-46 years suffered from uterine rupture at Mansa General Hospital, a referral center for Luapula province. Adolescent women were significantly more likely to have had a uterine rupture than all women delivering (38% vs. 17%; p 0.01). Nulliparity was more common among the uterine rupture cases than among all women giving birth (44% vs. 27%; p 0.05). Multiparity was just as common. 63% of uterine rupture cases had had no prenatal care. In 94% of cases the rupture occurred during labor. Some identified contributing factors for uterine rupture were cephalopelvic disproportion (24 cases), previous cesarean section (3), and oxytocic stimulation and assisted breech delivery with undiagnosed mild hydrocephalus (2). 44% of the women died postoperatively. Sepsis was the leading cause of death (79%). Mortality was associated with nulliparity (79%), adolescence (71%), and anemia, sepsis, and shock on admission (64%). Sepsis and maternal death increased with time since rupture and distance between patient's home or referring center and hospital. Prenatal care did not affect maternal death. All the babies died. These findings emphasize the need for health education of rural residents, training and supervision of traditional birth attendants, and available transportation. In cases of uterine rupture, later marriage, family planning use, and obstetric care may improve maternal prognosis.