Risk factors for ruptured uterus in Mulago hospital Kampala, Uganda.

OBJECTIVE: To determine the risk factors for ruptured uterus. DESIGN: A case control study. SETTING: Mulago Hospital labour wards, Kampala, Uganda. SUBJECTS: Fifty two women with ruptured uterus were recruited between 15th November 2001 and 30th November 2002 and were compared with 500 mothers with normal delivery. RESULTS: The predictors for ruptured uterus were low socio-economic (OR 2.5, 95% CI 1.2-7.1), residing more than ten kilometres from Mulago hospital (OR 6.7, 95% CI 2.1-21.2). Delivery by Caesarean section in previous pregnancy (OR 22.3, 95% CI 9.2-54.2) delivery of babies weighing more than 3500 grams (OR 2.4, 95% CI 1.2-7.2) and testing HIV positive (OR 3.2, 95% CI 1.5-7.2). CONCLUSION: Uterine rupture is still common in our society and is associated with severe maternal morbidity and mortality. There is need for women to use maternity units during pregnancy and delivery, to monitor labour using a partograph and timely intervention of delivery will prevent uterine rupture.

Maternal mortality and associated near-misses among emergency intrapartum obstetric referrals in Mulago Hospital, Kampala, Uganda.

BACKGROUND: Many maternal deaths (as well as related severe morbidity) are of women who do not attend antenatal care in a given health unit but are referred there when they develop life-threatening obstetric complications. OBJECTIVE: To determine the reproductive characteristics of emergency obstetric referrals, and determine the contribution of emergency obstetric referrals to severe acute maternal morbidity (near-misses) and maternal mortality. STUDY DESIGN: Descriptive cross-sectional study. SETTING: Mulago hospital, the National Referral hospital, Kampala, Uganda, from 1st March to August 30th 2000. SUBJECTS: Nine hundred and eighty three consecutive women admitted as emergency obstetric referrals in labour or puerperium. INTERVENTIONS: Subjects were followed from time of admission to discharge (or death). They were interviewed (or examined) to obtain data on socio-demographic characteristics, reproductive history, obstetric outcome of the index pregnancy, obstetric complications and cause of death. Their records were reviewed to determine evidence of severe acute morbidity from acute organ/system dysfunction, using the definition by Mantel et al. These data were analysed using the Epilnfo computer programme in terms of means, frequencies and percentages. MAIN OUTCOME MEASURES: Socio-demographic characteristics, obstetric complications, cause of deaths, cause and type of near miss mortality and case fatality rates. RESULTS: Of the 983 referrals, over 100 were near-misses and 17 died. Using the definition of Mantel et al of near-misses enabled identification of six times as many near-misses as maternal deaths. The commonest causes of death were postpartum haemorrhage and eclampsia. Low status was highly associated with both maternal deaths and near misses. CONCLUSION: In developing countries, with poor obstetric services, emergency transfers in labour are very common. These women, who are of low status, contribute significantly to maternal mortality and morbidity.