Emerging Trend in the Aetiological Pattern of Ruptured Pregnant Uterus in Northern Nigeria

Abstract

Background: Rupture of the pregnant uterus contributes to maternal and perinatal morbidity as well as mortality in Nigeria. There is a need to look into the aetiological factors against the background of low contraceptive prevalence rate, increasing caesarean section rate, and level of expertise of the cadre of healthcare workers practicing at lower levels of healthcare from where most of the referrals come from. The objective of the study was to review the aetiology and risk factors of ruptured pregnant uteri managed at a tertiary healthcare institution in Northern Nigeria. Is there a departure from the previous pattern of aetiology of the ruptured uterus? Methodology: A retrospective descriptive study. Medical records of all consecutive patients who presented with ruptured uterus between January 2015 and December 2018 were retrieved. Relevant data were extracted and analysed. Results: A total of 16 patients presented with ruptured uterus which was 0.24% of the total deliveries of 6,677 during the period of study. The total cesarean section during the period of study was 2,386, constituting 35% of the total deliveries. The patients' age range was 17 to 37 years with a mean of 28.9 ± 5.5 years. Ten (62.5%) were unbooked for antenatal care while 15(93.8%) were multipara with 6 (40%) of these being Para 5 and above. Up to 7(43.8%) had at least a previous caesarean section. More than half of 9(56.3%) had injudicious use of oxytocics either at home or at the referring lower level healthcare centre. Misoprostol was the most abused 7(77.8 %) alone or in combination with oxytocin. There was 1(6.3 %) maternal mortality before she could be gotten to the theatre while only 2(12.5%) live births were achieved. Conclusion: Oxytocics especially Misoprostol are dangerous in the hands of those not trained to use them. Antenatal care, training, and retraining of Health workers and probable restrictions of misoprostol would help reduce maternal and perinatal mortality from uterine rupture.