MAGNITUDE OF UTERINE RUPTURE AND ASSOCIATED FETO-MATERNAL OUTCOMES AMONG WOMEN WHO GAVE BIRTH AT HIWOT FANA COMPREHENSIVE SPECIALIZED UNIVERSITY HOSPITAL, HARAR, ETHIOPIA

Abstract

Background: Uterine rupture is a serious obstetric emergency whereby the uterine wall is disrupted and loses its integrity. Although its prevalence in Africa ranges from 0.3 to 2.4%, it is one of the major causes of maternal mortality. However, evidence on its burden and associated factors is limited in many settings, including in Ethiopia. Objective: To assess magnitude of uterine rupture and associated feto-maternal outcomes among women who gave birth at Hiwot Fana Comprehensive Specialized University Hospital, Harar, Ethiopia from October 1 to 31, 2023. Methods: This study was conducted at the department of obstetrics and gynecology, Hiwot Fana Specialized University Hospital in Ethiopia. All cases of uterine rupture cases January 1, 2018 to December 31, 2022 were identified from the operating room logbook, admission-discharge register, and delivery logbook. Data was collected through a pre-tested questionnaire and entered into SPSS 26 for analysis. Descriptive statistics were used to characterize the sample, and binary and multivariable logistic regression identified factors associated with feto-maternal outcome, with odds ratios, confidence intervals, and a p-value threshold of 0.05 for significance. Results: Among 24,608 deliveries during the five years, 168 (7 per 1000 deliveries) confirmed cases of uterine rupture were admitted in the hospital. We included 153 cases for which complete information was obtained. The mean age of the women was 27.76 (+SD) 5.25 years. (73.9%) experienced severe blood loss or required a transfusion of at least two units of blood. There were 13(8.5%) bladder rupture, 9 (5.9%) vesicovaginal fistulas, and 5(3%) maternal death. With regard to fetal outcomes, there were 139 (90.8) stillbirths (all fresh) no antenatal care (over fivefold increased risk) (AOR 5.9, 95% CI 1.1-31.7), emerged as the only significant risk factors with adverse feto-maternal outcomes. Conclusion: Uterine rupture complicates 7 per 1000 births in the hospital. Although this seems a rare occurrence, it has high burden of adverse feto-maternal outcomes: hysterectomy and death? Audit of these cases is essential for understanding quality of care and delays in the care and pathways for improving care.