Patterns of uterine rupture in Nigeria: a comparative study of scarred and unscarred uterus

Background: Study aims to explore the differences in presentation, management and outcome of uterine rupture among patients with and without previous uterine scar.Methods: A 5-year retrospective cross-sectional study of all cases of uterine rupture in Nigerian Christian Hospital. Data was analyzed using descriptive statistics, chi-square and logistics regression.Results: Incidence of uterine rupture was 14.6 per 1,000 live births (n=70; 40% unscarred uterus, 60% scarred uterus). Lateral rupture was more common with unscarred uterus (n=27; 39%) compared with anterior rupture in scarred uterus (n=43; 71%). Rupture of unscarred uterus often involved the cervix and vagina, while scarred uterus involved the bladder (P= 0.03). More cases with unscarred uterus resulted in hysterectomy (n=3; 14%) versus scarred uterus (n=2; 5%). Unscarred uterus was associated with more haemorrhage 771 (± 670) mL compared with 403 (±585) mL for scarred uterus (P= 0.02). Fetal survival was higher with scarred uterus (P= 0.04). There was no significant difference in the incidence of peri-operative complications between the groups.Conclusion: Rupture of scarred uterus was more common, while rupture of unscarred uterus was associated with more feto-maternal morbidity and mortality. Increase in caesarean section procedures in developing countries could increase the incidence of uterine rupture in these regions, thus prompting a need for improvement in obstetrics care.