Uterine rupture in Mekelle, northern Ethiopia, between 2009 and 2013

Objective: To review cases of uterine rupture at a center in northern Ethiopia. Methods: In a retrospective chart review, data were assessed for cases of symptomatic uterine rupture treated at Ayder Referral Hospital in Mekelle between January 1, 2009, and December 31, 2013. Results: In the 5-year study period, there were 5185 deliveries and 47 cases of uterine rupture, giving a rate of one case per 110 deliveries. All patients underwent laparotomy for suspected uterine rupture. Mean parity was 3.6 (range 0-8). The most common predisposing factors were cephalopelvic disproportion (35 [74%] patients), previous cesarean delivery (5 [11%)], and fetal malpresentation (4 [9%]). Hysterectomy was undertaken for 35 (74%) patients; the other 12 (26%) were treated conservatively by simple repair of the rupture. There were 44 (95%) stillbirths and 1 (2%) maternal death. Conclusion: Uterine rupture remains an important clinical problem in northern Ethiopia. Changes in the cultural preference for home delivery, better transport and referral systems, and improved obstetric training and hospital management of laboring women are needed.