Objective: show the epidemiological and prognostic aspects of uterine ruptures on scarred uterus in N’djamena the mother and Child University Hospital.
Patients and Methods: retrospective cross-sectional observational study conducted from 25 November 2020 to 24 November 2021, covering 235 deliveries on scarred uteri, of which 26 cases of uterine ruptures were diagnosed and operated on. The variables studied were sociodemographic, reproductive, clinical, therapeutic and prognostic. The data collected were analyzed using SPSS software. Absolute and relative frequencies and variables of interest were calculated.
Results: a total of 235 deliveries on scarred uteri were recorded, among which 26 cases of uterine ruptures were reported, representing a frequency of 11.1%. The 30-35 age group was the most affected The 30-35 age group was the most affected (38.5%), with a mean age of 28 ± 6.51 years and extremes of 18 and 41 years. The patients were married (96.2%); had no schooling (76.9%) and had few children (61.5%). Most patients were referred (57.7%) and the ambulance was used as a means of transport (50%). The intergenetic interval was greater than or equal to 24 months (38.4%). Prenatal care consisted of 1 to 3 antenatal visits in 46.2% of cases. Labor had started at home for 96.2% of the women, with a maximum duration exceeding 18 hours in 73.1%. Obstetric maneuvers were performed in 30.8% of cases. Uterine bleeding was the main reason for referral in 88.5%; hemoglobin levels were between 7 and 10 g/dl in 57.7%. The rupture was complete in 50% of cases, segmental in 69.2%, and associated injuries (bladder, uterine pedicle, and bowel) were reported in 23.1%. Hysterorrhaphy without tubal ligation was performed in 56.7%. We reported that newborns from incomplete ruptures were alive in 46.2% of cases, while those from complete ruptures were deceased in 50%.
Conclusion: The prevalence of uterine rupture in scarred uteri remains high, especially with the advent of free emergency cesarean sections in our context. However, awareness and information regarding previous diagnoses and assessment of the old scar, good quality monitoring of the pregnancy, and avoiding delays in the decision to bring the laboring woman to the hospital could help reduce the risk of uterine rupture in scarred uteri.
International Journal of Clinical Obstetrics and Gynaecology
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