Management and outcomes of uterine rupture at a regional referral hospital in Senegal

Uterine rupture remains a major obstetric emergency in resource-limited settings. This study described its epidemiological, clinical, therapeutic, and prognostic features at the El Hadji Ibrahima Niass Regional Hospital in Kaolack, Senegal. We conducted a retrospective descriptive and analytical study including all uterine ruptures diagnosed and managed between 1 January 2021 and 31 December 2022. Data were extracted from medical records and analysed using SPSS version 20.0. Among 11,290 deliveries, 51 uterine ruptures were identified, corresponding to a hospital frequency of 0.45%. The estimated mean age was 30.2 years (range 20-42), 58.8% of women were multiparous or grand multiparous, and 92.2% were referred from another facility. Rupture occurred in an unscarred uterus in 60.8% of cases and was complete in 88.2%. Conservative uterine repair was performed in 70.6%, whereas 29.4% underwent hysterectomy. Twelve maternal deaths occurred, yielding a case fatality rate of 23.5%; fetal mortality was 78.4%. In bivariate analysis, maternal death was associated with parity (p = 0.028), mode of delivery (p = 0.004), and type of surgery (p < 0.001). Uterine rupture was associated with very high maternal and fetal mortality. Earlier diagnosis and referral, rigorous labour monitoring, and immediate access to surgery, resuscitation, and blood products are priorities.