Prevalence, Obstetric Characteristics, Clinical Presentations and Outcomes of Patients Managed for Uterine Rupture at Kenyatta National Hospital Between January 2016 and December 2020. (a Descriptive Retrospective Cross-sectional Study)

Abstract

Introduction: Uterine rupture is one of the leading causes of poor maternal and neonatal outcomes. Globally, the prevalence of uterine rupture is as low as 0.07%. However, in comparison to the global prevalence, there is unacceptably high prevalence of uterine rupture in sub-Saharan Africa, Kenya inclusive (1.3%). There is dearth of recent studies on the prevalence, obstetric characteristics, clinical presentation, and outcomes of patients managed for uterine rupture in Kenya. Thus, this study aimed to determine the prevalence, obstetric characteristics, clinical presentation, and outcomes of patients managed for uterine rupture at Kenyatta National Hospital (KNH), a referral hospital in Nairobi. Information obtained in this study is vital in planning strategies to reduce the adverse outcomes of uterine rupture. Material and methods: This was a descriptive, retrospective cross-sectional study of patients managed for uterine rupture at KNH between January 1, 2016 and December 31, 2020. A total of 143 patients managed for uterine rupture cases were sampled from 69,190 deliveries during the study period. Relevant information about the prevalence, obstetric characteristics, clinical presentation, and outcomes were extracted from medical records, maternity theatre, statistics and maternal mortality reviews using abstraction form. The information were computerized and analyzed using SPSS 21.0 version. Results: The prevalence uterine rupture was 0.21 % (1:484 deliveries). The mean age of the participants was 29.2 (± 5.2), and median 29.0 (IQR 25.5-33.0) years. The most obstetric and labor characteristics were previous caesarian delivery (69.2%), unsupervised labor (26.6%) and obstructed labor in the unscarred uterus (22.4%). The most common surgical intervention was uterine repair in 125 (87.4%), and 82 (57.3%) patients required blood transfusion. Abdominal pain (91.1%) and abdominal tenderness (62.2%) were the leading clinical presentations. Meanwhile the adverse maternal, stillbirths and neonatal deaths were 7.0%, 69.2% and 6.3% respectively. Conclusion: There was high prevalence of uterine rupture in the study site. Previous CS delivery, obstructed labor and unsupervised labor, and abdominal pain were the leading obstetric and labor characteristics that predisposed uterus to rupture. Patients’ education and improved maternity services may lead to a reduction of adverse maternal and fetal outcomes secondary to uterine rupture.