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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2017

Open Access 01-12-2017 | Research article

Evaluation of obstetricians’ surgical decision making in the management of uterine rupture

Authors: Justus Ndulue Eze, Okechukwu Bonaventure Anozie, Osaheni Lucky Lawani, Emmanuel Okechukwu Ndukwe, Uzoma Maryrose Agwu, Johnson Akuma Obuna

Published in: BMC Pregnancy and Childbirth | Issue 1/2017

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Abstract

Background

Uterine rupture is an obstetric calamity with surgery as its management mainstay. Uterine repair without tubal ligation leaves a uterus that is more prone to repeat rupture while uterine repair with bilateral tubal ligation (BTL) or (sub)total hysterectomy predispose survivors to psychosocial problems like marital disharmony.
This study aims to evaluate obstetricians’ perspectives on surgical decision making in managing uterine rupture.

Methods

A questionnaire-based cross-sectional study of obstetricians at the 46th annual scientific conference of Society of Gynaecology and Obstetrics of Nigeria in 2012. Data was analysed by descriptive and inferential statistics.

Results

Seventy-nine out of 110 obstetricians (71.8%) responded to the survey, of which 42 (53.2%) were consultants, 60 (75.9%) practised in government hospitals and 67 (84.8%) in urban hospitals, and all respondents managed women with uterine rupture. Previous cesarean scars and injudicious use of oxytocic are the commonest predisposing causes, and uterine rupture carries very high incidences of maternal and perinatal mortality and morbidity. Uterine repair only was commonly performed by 38 (48.1%) and uterine repair with BTL or (sub) total hysterectomy by 41 (51.9%) respondents. Surgical management is guided mainly by patients’ conditions and obstetricians’ surgical skills.

Conclusion

Obstetricians’ distribution in Nigeria leaves rural settings starved of specialist for obstetric emergencies. Caesarean scars are now a rising cause of ruptures. The surgical management of uterine rupture and obstetricians’ surgical preferences vary and are case scenario-dependent. Equitable redistribution of obstetricians and deployment of medical doctors to secondary hospitals in rural settings will make obstetric care more readily available and may reduce the prevalence and improve the outcome of uterine rupture. Obstetrician’s surgical decision-making should be guided by the prevailing case scenario and the ultimate aim should be to avert fatality and reduce morbidity.
Appendix
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Literature
1.
Fofie CO, Baffoe P. A two-year review of uterine rupture in a regional hospital. Ghana Med J. 2010;4(3):98–102.
2.
Eze JN, Ibekwe PC. Uterine rupture at a secondary hospital in Afikpo, south-east Nigeria. Singap Med J. 2010;51(6):506–11.
3.
Walsh CO, Baxi LV. Rupture of the primigravid uterus: a review of literature. Obstet Gynecol Surv. 2007;62(5):327–34.CrossRefPubMed
4.
Esike CO, Umeora OU, Eze JN. Ruptured uterus: the unabating obstetric catastrophe in south eastern Nigeria. Arch Gynecol Obstet. 2011;283(5):993–7.CrossRefPubMed
5.
Ezechi OC, Mabayoje P, Obiesie LO. Ruptured uterus in south western Nigeria: a reappraisal. Singap Med J. 2004;45:113–6.
6.
van den Akker T, Mwagomba B, Irlam J, van Roosmalen J. Using audits to reduce the incidence of uterine rupture in a Malawian district hospital. Int J Gynecol Obstet. 2009;107(3):289–94.CrossRef
7.
Khan S, Parveen Z, Begum S, Alam I. Uterine rupture: a review of 34 cases at Ayub teaching hospital Abbottabad. J Ayub Med Coll Abbottabad. 2003;15(4):50–2.PubMed
8.
9.
Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP. Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med. 2001;345(1):3–8.CrossRefPubMed
10.
Fitzpatrick KE, Kurinczuk JJ, Alfirevic Z, Spark P, Brocklehurst P, et al. Uterine Rupture by Intended Mode of Delivery in the UK: A National Case-Control Study. PLoS Med;9(3): e1001184. doi:10.​1371/​journal.​pmed.​1001184.
11.
Aboyeji AP, Ijaiya NA, Yahaya UR. Ruptured uterus: a study of 100 consecutive cases in Ilorin, Nigeria. J Obstet Gynecol Res 2001;27(6):341-348.
12.
Dattijo LM, Umar NI, Yusuf BM. Ruptured uterus in Azare, northeastern Nigeria. Jos Med J. 2011;5(2):17–20.CrossRef
13.
Chew SY. Uterine rupture in labour. A 10-year review. Singap Med J. 1984;25:24–9.
14.
Ezegwui HU, Nwogu-Ikojo EE. Trends in uterine rupture in Enugu, Nigeria. J Obstet Gynaecol. 2005;25(3):260–2.CrossRefPubMed
15.
Ogunnowo T, Olayemi O, Aimakhu CO. Uterine rupture: the UCH, Ibadan experience. WAJM. 2003;22(3):236–9.
16.
Njoku CO, Iklaki CU, Emechebe CI, Abeshi SE, Agbakwuru A. Demographic profile of patients with uterine rupture at the University of Calabar Teaching Hospital (UCTH), Calabar: a ten year-review. Pioneer Med J. 2015;4(8):1–13.
17.
18.
19.
Ebeigbe PN, Enabudoso E, Ande AB. Ruptured uterus in a Nigerian community: a study of sociodemographic and obstetric risk factors. Acta Obstet Gynecol Scand. 2005;84:1172–4.CrossRefPubMed
20.
Ojenuwah SA, Olowosulu RO. Surgical management of ruptured gravid uterus in Bida, north Central Nigeria. Trop Dr. 2007;37:219–21.CrossRef
21.
Gessessew A, Melese MM. Ruptured uterus-eight year retrospective analysis of causes and management outcome in Adigrat hospital, Tigray region, Ethiopia. Ethiop J Health Dev. 2002;16:241–5.
22.
23.
24.
Ahmed SM, Daffalla SE. Incidence of uterine rupture in a teaching hospital, Sudan. Saudi Med J. 2001;22(9):757–61.PubMed
25.
26.
Mbaruku G, van Roosmalen J, Kimondo I, Bilango F, Bergström S. Perinatal audit using the 3-delays model in western Tanzania. Int J Gynecol Obstet. 2009;106:85–8.CrossRef
27.
Rizwan N, Abassi RM, Uddin SF. Uterine rupture, frequency of cases and fetomaternal outcome. J Pak Med Assoc. 2011;61(4):322–4.PubMed
28.
World Health Organization. WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture. BJOG. 2005;112:1221–8.CrossRef
29.
Adesiyun AG, Eseiegbe E, Ameh CA. Inevitable peripartum hysterectomy in a tropical hospital: indications and maternofetal outcome. Pak J Med Sci. 2008;24(1):122–6.
30.
31.
Bibi S, Gul K, Gul Z, Gul P. Management of patients with uterine rupture. J Surg Pak (International). 2014;19(3):117–20.
32.
33.
Agboghoroma C, Achem FF. Directory of Obstetricians and Gynaecologist in Nigeria 2012. Society of Gynaecology and Obstetrics of Nigeria (SOGON); 2012.
34.
Berhe Y, Wall LL. Uterine rupture in resource-poor countries. Obstet Gynecol Surv. 2014;69:695–707.CrossRefPubMed
35.
36.
37.
Eniola AB, Adebiyi AO, Fatiregun AA. Assessment of emergency obstetric care services in Oyo state Nigeria. Ann Commun Med Pract. 2015;1(2):1009.
38.
Mezie-Okoye MM, Adeniji FO, Tobin-West CI, Babatunde S. Status of emergency obstetric Care in a Local Government Area in south-South Nigeria. Afr J Reprod Health. 2012;16(3):170–9.
39.
Nyantema AS, Mwakatundu N, Dominico S, Mohamed H, Pemba S, Rumanyika R, et al. Enhancing maternal and Perinatal health in under-served remote areas in sub-Saharan Africa: a Tanzanian model. PLoS One. 2016;11(3):e0151419. doi:10.​1371/​journal.​pone.​0151419.CrossRef
40.
Nyamtema A, Mwakatundu N, Dominico S, Mohamed H, Shayo A, Rumanyika R, et al. Increasing the availability and quality of caesarean section in Tanzania. BJOG. 2016; doi:10.​1111/​1471-0528.​14223.
41.
Umeora OU, Ejikeme BN, Egwuatu VE. Contribution of ruptured uterus to maternal mortality in rural south eastern Nigeria request article. Trop J Obstet Gynaecol. 2005;22(2):184–8.
42.
Onoh RC, Eze JN, Ezeonu PO, Lawani LO. A 10-year appraisal of cesarean delivery and the associated fetal and maternal outcomes at a teaching hospital in southeast Nigeria. Inter J Womens Health. 2015;7:531–8.CrossRef
Metadata
Title
Evaluation of obstetricians’ surgical decision making in the management of uterine rupture
Authors
Justus Ndulue Eze
Okechukwu Bonaventure Anozie
Osaheni Lucky Lawani
Emmanuel Okechukwu Ndukwe
Uzoma Maryrose Agwu
Johnson Akuma Obuna
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2017
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-017-1367-8

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