Predictors of uterine rupture in a large sample of women in Senegal and Mali: cross-sectional analysis of QUARITE trial data - Delafield, Rebecca; Pirkle, Catherine M.; Dumont, Alexandre (BMC Pregnancy and Childbirth, 2018)
BackgroundThe purpose of this study was to investigate predictors of uterine rupture in a large sample of sub-Saharan African women. Uterine rupture is rare in high-income countries, but it is more common in low-income settings where health systems are often under-resourced. However, understanding of risk factors contributing to uterine rupture in such settings is limited due to small sample sizes and research rarely considers system and individual-level factors concomitantly.MethodsCross-sectional data analysis from the pre-intervention period (Oct. 1, 2007- Oct. 1, 2008) of the QUARITE trial, a large-scale maternal mortality study. This research examines uterine rupture among 84,924 women who delivered in one of 46 referral hospitals in Mali and Senegal. A mixed-effects logistic regression model identified individual and geographical risk factors associated with uterine rupture, accounting for clustering by hospital.ResultsFive hundred sixty-nine incidences of uterine rupture (0.67% of sample) were recorded. Predictors of uterine rupture: grand multiparity defined as >5 live births (aOR=7.57, 95%CI; 5.19-11.03), prior cesarean (aOR=2.02, 95%CI; 1.61-2.54), resides outside hospital region (aOR=1.90, 95%CI: 1.28-2.81), no prenatal care visits (aOR=1.80, 95%CI; 1.44-2.25), and birth weight of >3600g (aOR=1.61, 95%CI; 1.30-1.98). Women who were referred and who had an obstructed labor had much higher odds of uterine rupture compared to those who experienced neither (aOR: 46.25, 95%CI; 32.90-65.02).ConclusionsThe results of this large study confirm that the referral system, particularly for women with obstructed labor and increasing parity, is a main determinant of uterine rupture in this context. Improving labor and delivery management at each level of the health system and communication between health care facilities should be a priority to reduce uterine rupture.
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