[Uterine rupture of pregnant uterus: study of a continuous series of 63 cases at the referral maternity of Niamey (Niger)]

Abstract

Uterine rupture contributes significantly to high maternal mortality rates in developing countries. We conducted a prospective study of 63 cases of uterine rupture during pregnancy in the Gazobi Hospital in Niamey, Niger between November 1977 to December 1998. The incidence in the maternity department was 2.3%. Most of the patients were transported from inland areas. Mean age was 29 years, and mean parity was 5.7. More than half of patients (53%) presented uterine scar defects. Two thirds of patients had undergone no prenatal care. Analysis of iatrogenic etiologic factors demonstrated strong correlation with use of oxytocin, forceps delivery and fundal pressure. In 75% of cases, diagnosis of uterine rupture was made before delivery. The main symptom was hemorrhage. Surgical treatment consisted of hysterorraphy in 79% of the cases. Maternal mortality was 4.7% and perinatal mortality was 76%. Discussion focuses on the frequency of uterine rupture in developing countries, etiologic factors, diagnostic modalities, and therapeutic guidelines. Several simple preventive measures are proposed to reduce the incidence of uterine rupture in developing countries.