Surgery and Healing in the Developing World - Dartmouth-Hitchcock

CHAPTER 1
CHAPTER 31
Uterine Ruptures in Rural Zaire
Ahuka Ona Longombe, K.M. Lusi and P. Nickson
Summary
Uterine rupture with its deplorable sequelae constitutes a major obstetrical problem
in the rural area of Africa. The maternal and perinatal mortality remain high as
a result, mainly due to the lack of early and adequate care for these patients. Multiparity
of the major predisposing factors. Prevention must necessarily include the
availability of family planning advice, improved organization of and access to maternal
care, and good supervision during delivery and the post-partum period. The
general improvement of the overall socio-economic conditions is a precondition to
the improvement of access to care.
Introduction
Uterine rupture is unfortunately still a common event in African rural areas. 1-4
Its decreased incidence in the West 5 is because of the excellent supervision of pregnant
women. Uterine rupture still poses a great problem in African countries. There
are several reasons for this. First, prenatal care is commonly inadequate or inaccessible,
with consequent failure to detect many high risk pregnancies, especially those
of grande-multiparous women. Secondly, the lack of a good health infrastructure
for the correct and rapid transfer of these patients makes their prognosis precarious
in rural areas. Lastly, the continuously deteriorating socio-economic conditions mean
that health care has now become a luxury. In this chapter we describe the problem of
uterine rupture in a rural hospital in North Eastern Zaire and underline the gravity
of consequent perinatal and maternal mortality.
The Study
A retrospective study was carried out at the Centre Médical Evangélique (CME),
Nyankunde, in North Eastern Zaire—a referral hospital with 250 beds providing
support for several other district hospitals and many health centres and health posts.
The analysis covers the period from 1 January 1980 to 31 December 1992 (13
years), and includes 76 cases of ruptured uterus necessitating surgical intervention
at Nyankunde.
Results
From a total of 21,599 deliveries conducted in our maternity department (5.8
cases per year, and a mean of 1 rupture: 284 deliveries) we have had 76 cases of
uterine rupture within 13 years. All of these patients were admitted as emergencies,
none being booked for delivery at our hospital. Most were referred from outside the
Surgery and Healing in the Developing World, edited by Glenn Geelhoed.