ASSESSMENT OF MANAGEMENT OUTCOME AND ASSOCIATED FACTORS OF UTERINE RUPTURE AMONG WOMEN WHO WERE DELIVERED AT JUGOL GENERAL HOSPITAL, HARARI REGIONAL STATE, EASTERN ETHIOPIA

Abstract

Background: Uterine rupture is a serious life threatening obstetric complication during child birth by which the integrity of myo metrial wall (uterine wall) is breached. It may occur more often during labor. It is caused as a result of scared uterus, obstructed labor or iatrogenic (oxytocin, instrumental delivery). There are two types of uterine rupture, incomplete and complete. In an incomplete rupture the peritoneum is still intact and complete not intact. Objective: The general objective of the study was to determine the management outcome and associated factors of ruptured gravid uterus in Jugol general Hospital retrieval of ( Jan1,2016 and Dec31,2017) from July20-30, 2018. Method: A retrospective cross sectional study design was used to assess the management outcome and associated factors of uterine rupture. A data retrieval format was used to collect data from delivery registration books, operation room record of 7274 patient data who were in Jugol General Hospital two years ( Jan1,2016 and Dec31,2017) reviewed from July20-30 , 2018.The data were pre-coded, cleaned, entered and analyzed using SPSS version 16. The data was presented in tables and figures using frequency, percentage, mean, standard deviation . Result: Out of total of 7274 hospital deliveries (Jan1,2016 and Dec31,2017), 98 cases of uterine rupture were admitted in Jugol general Hospital making the prevalence of 1.35% and only 65 cases had complete available data. XIII The common cause of uterine rupture were: cephlo- pelvic disproportion 35(53.85%), malpresentation and malpostion 19(29%), oxytocin induced 5(7.6%) ,uterine scar 2(3.08%) and forceps delivery 1(1.5%) Grand multipara with five or more deliveries represented 33.8% while those with one prior delivery represented 18.5%. The average mean parity was 3.5(SD=2.41) under Anti natal care, 76.92% had no ANC of which 80% was from outside Harar. Majority 55(84.6%) had complete rupture while 10(15.38%) had incomplete rupture. The most common site of ruptured uterus was lower uterine segment 48(73.8%) and right - lateral 7(10.77%). Of the total number of patients, 20 (30.77%) underwent total abdominal hysterectomy, sub-total abdominal hysterectomy and repair were equal 13(20%), Repair with BTL 11(16.9%), underwent combination of intervention. Three cases (4.6%) had associated bladder injury and 2(3%) had developed Vesico-Vaginal Fistula. Out of the total cases 46(71%) were anemic. From those who had Post-operative complication 11(30%) had developed wound infection. The majority of patient 58(89.2%) on average had transfused with at least two units of blood. Maternal case fatality rate was 5(8%) and fetal case fatality rate was 63(97%) and live birth rate (3.07%). The main causes of death among those died were septic shock 4(80%) and cardiac arrest 1(20%). Ruptured uterus contributed 6.67% of obstetric causes of maternal deaths in the hospital within the study period. Conclusion: Uterine rupture is still the common hazards at peak for maternal, fetal death and as well as victim of post-operative complication in the study area. Enhancing accessible emergency obstetric care and focused on an integrated effort to prevent the causes of uterine rupture and provision of refreshment skill training to health person to scale up management of uterine rupture to reduce maternal and perinatal mortality and morbidity.