Unmasking Uterine Rupture A Critical Call to Strengthen Maternal Healthcare in Lubumbashi

Introduction

Uterine rupture is a life-threatening obstetric emergency often under reported in low resource settings. A recent study conducted across nine referral maternities in Lubumbashi, Democratic Republic of Congo, sheds new light on the prevalence, risk factors, and tragic outcomes associated with this condition. The findings not only reveal critical data but also call for systemic improvements in maternal care practices.
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Key Findings from the Study

Conducted over a 4-year period (2012–2016) and analyzing 158 cases, the study highlighted:

• Prevalence: Uterine rupture occurred in 0.49% of deliveries.
• Demographics: Majority of cases involved women aged 20–34 with a high average parity (4.7 births).
• Risk Factors:
  • 57% had no antenatal care.
  • 83% of patients were referrals from peripheral maternities.
  • 81% had complete uterine ruptures, primarily in the lower uterine segment.
• Outcomes:
  • Maternal mortality: 8.86%
  • Perinatal mortality: 72.04%
• Surgical Response: 93% underwent uterine repair; 5% required hysterectomy.

Read the full study at: https://doi.org/10.29328/journal.cjog.1001067

Implications for Healthcare Systems

The high perinatal mortality rate and significant maternal risks identified in this study stress the urgency of strengthening healthcare systems in resource-limited settings.
The World Health Organization (WHO) stresses the importance of timely obstetric intervention and skilled birth attendance to reduce maternal and neonatal deaths (WHO Safe Motherhood).

• Poor infrastructure and delayed referrals are key contributors.
• Low antenatal visit rates reduce early detection opportunities.
• The high frequency of complete ruptures signals inadequate birth monitoring.

Clinical Significance

• Parity ≥4 increased perinatal death risk by 3.5 times.
• Complete rupture raised newborn mortality by 13.9 times.
• Segmento-corporeal lesions were six times more fatal than lower-segment ruptures.

These findings underscore the need for risk stratification during antenatal visits and timely surgical intervention.

Strengthening Obstetric Care The Way Forward

To reduce the devastating impact of uterine rupture, healthcare stakeholders should:

• Promote comprehensive antenatal care.
• Ensure referral systems are efficient and timely.
• Equip peripheral centers with emergency obstetric resources.
• Train midwives and OB-GYN teams on early signs and rapid intervention.

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