Management and prognosis of uterine rupture during labor in an under-medicalized country: about 513 cases collected at the Cocody University Hospital Center (Abidjan-Cote d'Ivoire)

摘要

Background: Even today, uterine rupture is necessary as an indicator of health status in developing countries, like Cote d'Ivoire. The objective of this study was to describe the factors influencing the management and the prognosis of this pathology in a level III maternity of a third world country. Methods: The study was made in Cocody University Hospital Center (Abidjan-Cote d'Ivoire). A retrospective descriptive study of all women with ruptured uterus during labor managed between January 2002 and December 2014 was conducted. It covered 513 cases of uterine ruptures collected in 13 years. Results: The overall incidence of uterine ruptures was 0.95% or 1 in 105 deliveries. Most cases occurred in women with unscarred uterus (76.8%) and 23.2% of women had a scarred uterus. Surgical treatment was radical by hysterectomy in 35.3% of all women. Treatment was more conservative by uterine suture in women from the communes of Abidjan and its suburbs (71%) versus 25% of women who came from inland towns (p=0.000). Maternal mortality rate was 5.8% and was significantly influenced by the type of surgery (p=0.000), by the time of uterine rupture (p=0.000) and by the transportation distance (p=0.000). Fetal mortality was 94.1% for all women. Conclusions: Uterine rupture still poses a major public health problem in under-developed countries. The multiplication of obstetric surgical units but also the availability of blood products and the effectiveness of free care will be a vital contribution to effectively and sustainably improve the prognosis of this serious pathology when just constituted.