Surgery and Healing in the Developing World - Dartmouth-Hitchcock

31
326 Surgery and Healing in the Developing World
Table 1. Incidence of ruptured uterus
Annual Incidence of
Year Uterine Ruptures Total of Deliveries Ruptured Uterus
1980 3 1649 1/550
1981 3 1851 1/617
1982 4 1816 1/454
1983 1 1900 1/1900
1984 3 1955 1/652
1985 6 2027 1/338
1986 4 2192 1/548
1987 11 1918 1/174
1988 5 1327 1/265
1989 13 1244 1/96
1990 9 1323 1/147
1991 3 1246 1/415
1992 11 1151 1/105
TOTAL 76 21,599 1/284 (mean)
Health District of Nyankunde. Accordingly it is impossible to establish the actual
incidence within each Health District.
The apparent increase of incidence seen over this period (Table 1) may be attributed
to a deterioration of socio-economical conditions, but it is also partly due to
increased professional maternity care and subsequently more frequent referrals from
other health districts. Previously many more women would have died at home without
the knowledge of the medical centres.
Aetiologies
Of 76 uterine ruptures, 55 (72%) were primary ruptures, and were mainly due
to mechanical causes (obstructed labour). Twenty-one patients (28%) had a secondary
rupture following previous uterine surgery (Caesarean section 19 cases, myomectomy
two cases).
Interventions and Maternal Mortality
Of 75 patients who received surgical interventions, 42 (56%) had a repair of the
uterus while 33 (44%) of the cases had a hysterectomy. One additional patient arrived
dead and had only a postmortem exploration (Table 2).
The indication for a hysterectomy was rupture of the uterus which would have
been difficult to repair, the occurrence of a second rupture (denoting therefore the
Table 2. Interventions and maternal mortality
Intervention No. of Cases Deaths
Uterine repair 42 5
Hysterectomy 33 7
Total 75 12