Uterine Rupture : a retrospective

analysis of causes, complications

and management outcomes at
Muhimbili National Hospital in Der
es Salaam, Tanzania
Hussein L. Kidanto, Ipyana Mwampagatwa and Josh Van Roosmalen
 GROUP 3
Ferdian Rifqy N. F. (1413010011)

Venda Happy P. (1413010019)

Fatimah Qonitah D. (1413010029)

Nadya Ratu A.Z. (1413010031)

Arsya Firdaus (1413010032)

Arumita Puspa H. (1413010038)

Anissa Kusuma D. (1413010042)

Sony Andik P. (1413010045)

Arista Lestiyani (1413010048)

Raden Maghfira K.K. (1413010049)

Introductions
Rupture of the unscarred uterus is much more frequent in lo
w-income countries.
Several studies from Africa and Asia, shows that about 7
5% of cases of uterine rupture occurred in women with
an unscarred uterus, with obstructed labour being the m
ost common cause.
Material and Methods
Study area

The study was in of the Muhimbili National Hospital

The hospital serves as a referral centre for the city of Dar es Salaam and th
e neighbouring regions.
Annual number of deliveries is about 10,000, corresponding to about 30 del
iveries per day, out of which 80% are low-risk deliveries.
 Study design and data collection

Case notes for all women with the diagnosis of uterine rupture from
January 1st 2003 to December 31st 2009
information was abstracted on the date of birth, antenatal care attendance,
source of admission, place of diagnosis, maternal age, parity, birth weight,
sex and vital status of the baby at birth (Apgar score at 1 and 5 minutes),
Physical examination findings during admission, causes of uterine rupture,
intra-operative findings and type of surgical intervention.
 Data analysis

Data was entered using EpiInfo 6 software, cleaned and analyzed with
PAWS 18 statistics package.
Uterine rupture was defined (abdominal pain, abnormal fetal heart rate pa
ttern, acute loss of contractions, vaginal blood loss)
leading to an emergency caesarean delivery, at which the presumed diag
nosis of uterine rupture was confirmed or peripartum hysterectomy or lap
arotomy was done for uterine rupture.
Cases of scar dehiscence found during elective caesarean section
without proceeding clinical symptoms were not included.
Ethical considerations

Ethical clearance for this study was granted by the ethics and publication co
mmittee of Muhimbili University of Health and Allied Sciences
Names and other identity of clients were not disclosed to keep confidentiality
.
RESULTS
Discussion
 The incidence of ruptured uterus at MNH has not changed over
time and it has remained high despite a significant drop in the n
umer of deliveries and rise in the cesarean section rate. This mi
ght be due to inadequate monitoring of patient on trial of scar,
delayed refferal and delayed operative intervetion due to long q
ueue in blood loss. But the incidence in this study is lower than
that found in studies in other country. Major obstetric haemorrh
age was the most common presenting symptom of uterine rupt
ure in this study, therefore differential diagnosis of major obstet
ric haemorrhage should always include rupture uterine.
 from the hospitals need for blood overhelmed by many patients
requiring blood transfusion , therefore in emergency situatio nlik
e ruputure uterus they may be less blood than required for resu
sitation of the patient. All primigarvid with rupture uterus had the
ir labour augmented with oxytocin andmisoprostol. This unusual
ly high number for Tanzania comunities because in Tanzania loc
al herbs with oxytocin effect are widely used. In Tanzania 95%
women attends antenatal care clinic at least once in the gravid.
They have opportunity to plan for place timing and mode of deli
very although this has been questioned in the literature.
Conclusion
In conclusion, the incidence of ruptured uterus at Muhimbili
National Hospital ishigh and contributes significantly to bot
h maternal and foetal morbidity and mortality. Proper monit
oring of labour both in the referring facilities and at MNH an
d improvement of comprehensive emergence obstetric car
e in all levels will contribute to the reduction of these morbi
dities and mortalities related to ruptured uterus.
Thank You