Rupture of unscarred uterus: a multi-year cross-sectional study from Nigerian Christian Hospital, Nigeria

Background: Rupture of the gravid uterus is a known catastrophic event in obstetrics. Rare in developed countries, it contributes to the high maternal mortality in developing countries like Nigeria. Little is known about the determinants of rupture in unscarred uterus, especially in Nigeria, unlike rupture of scarred uterus. This paper studied the factors associated with rupture of unscarred uterus in Nigerian Christian Hospital.Methods: This was a multi-year, cross-sectional descriptive study of all cases of primary uterine rupture in the hospital between May 2002 and October 2007. Key factors studied include demographics, place of initial presentation in labour, use of uterotonics, duration of labour, maternal and fetal outcome, injury to structures adjacent to the uterus as well as type of surgical intervention.Results: Rupture of unscarred uterus comprised 40% (n=28) of rupture in the study period, with incidence of 8.4 per 1,000 births in the hospital. Most cases aged 25-34 years with parity of 3 or above. A significant proportion of cases were first managed by Traditional Birth Attendants (p=0.01, α=0.05), and there was statistically significant association between prolonged labour and initial presentation to TBAs (χ2 =16.44, P<0.001, α=0.05). Contiguous injuries to the cervix/vagina were most common among the cases. The associated maternal and perinatal mortality rates were 14% and 93% respectively.Conclusion: Primary uterine rupture was found to be associated with high parity and prolonged labour. Initial management by TBAs (with associated prolongation of labour) was strongly correlated to the occurrence of this event. It is recommended that health policy makers emphasize the deployment of competent health workers with obstetrics training in rural areas, to replace the traditional birth attendants.