Ruptured uterus in Mulanje CCAP Hospital, 1974-1982

Medical records of 194 patients with ruptured uteri at Mulanje CCAP Hospital in Malawi were studied from January 1974 to December 1982. The mortality rate was 10.3%; this figure was elevated with rupture of an intact uterus, primigravidity, rupture prior to hospital admissions, and being in shock when admitted. Fetal mortality was 70% and strongly correlated with maternal mortality. A stronger relationship was found between fetal mortality and shock, absence of scar, and time of rupture. Fetal mortality was also associated with surgery performed, completeness of rupture, and rupture diagnosis prior to delivery. Hysterectomies were performed in 33.3% of the cases. 3 groups were identified among the cases: unscarred uterus ruptured before admission, scarred uterus ruptured prior to admission, and scarred uterus ruptured in hospital. For the 1st group, factors contributing to the uterus rupture include cephalopelvic disproportion, malpresentation, prolonged labor, and herbal oxytocies. In this group, 57% were para 5. The majority of women in the other 2 groups were para 1-4. Incidences of shock varied between the 3 groups; the unscarred group had 67% with shock while the scarred ruptures had 38% (prior to admissions) and 8% (after hospital admission). An anterior rupture site was the most common site of uterus rupture; the findings are 49% for the 1st group, 81% for the 2nd group, and 90% for the 3rd group. The highest mortality rate (20%) was observed in women with unscarred uterus rupture before admission. Fetal mortality was 95%, 57%, and 27% for the 3 groups respectively. The major causes of death were shock and sepsis. Prolonged hospital stay was attributed to wound infection or vesico-vaginal fistula.