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  • Title: Uterine rupture in Nigeria.
    Author: Elkins T, Onwuka E, Stovall T, Hagood M, Osborn D.
    Journal: J Reprod Med; 1985 Mar; 30(3):195-9. PubMed ID: 3999069.
    Abstract:
    Uterine rupture in the developing world remains a significant problem. We treated 45 such cases. The predisposing factors included cephalopelvic disproportion (62%), grand multiparity (33%), previous cesarean section (24%), placental pathology (15%) and abnormal presentation (20%). The factors associated with maternal death included sepsis (71%), macerated stillborn infant (60%), vulvar edema (50%), hand presentation (50%), prolonged labor (42%) and hysterectomy (37.5%). Hemodynamic resuscitation and prompt surgical intervention remain the mainstays of therapy. Uterine rupture in the developing world remains a significant problem. 45 cases treated in a rural hospital in Nigeria are discussed in this article. The predisposing factors included cephalopelvic disproportion (62%), grand multiparity (33%), previous cesarean section (24%), placental pathology (15%) and abnormal presentation (20%). The factors associated with maternal death included sepsis (71%), macerated stillborn infant (60%), vulvar edema (50%), prolonged labor (42%), hand presentation (50%) and hysterectomy (37.5%). Hemodynamic resuscitation and prompt surgical intervention remain the mainstays of therapy. Patients ranged from ages 16 to 46, and gravidity ranged from 1 to 11. 38 of the 45 patients had no prenatal care. 8 of the 9 maternal deaths that occurred were among these 38. It is common for patients with uterine rupture to be admitted after uterine contractions have ceased, with profound dehydration and early septic or hemorrhagic shock. In 39 (87%) of the 45 cases, no fetal heart tones were heard on admission. 29 (58%) of the 45 uterine ruptures involved the lower uterine segment exclusively. Surgical procedures performed were hysterectomy in 8 cases and tubal ligations in 4 cases. The distinction between early and obstructed labor, cephalopelvic disproportion in the US, and true obstructed labor, as seen in rural Nigeria, is an important one. There often is a double-hump sign from the ballooning lower uterine segment in cases of long-obstructed labor, for which the patient may have been given an herbal powder. Numerous types of herbal mixtures have shown oxytocic properties and may contribute to the high incidence of uterine rupture. Prenatal care is an important preventive factor. Placental pathology appeared to play an etiologic role in several cases. The decision as to whether surgical repair or hysterectomy is the appropriate treatment is greatly influenced by cultural realities. Among the rural tribes of the Bendel State in Nigeria, fertility and the ability to menstruate are considered essential to a woman's worth within the community and in her family. Repair of a ruptured uterus is associated with lower maternal mortality than is hysterectomy and is therefore the preferred procedure.
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