Audit of uterine rupture in Maputo: a tool for assessment of obstetric care

Records of 96 women who had rupture of the uterus in labor were audited to find circumstances significantly associated with pregnancy outcome. The prevalence was 1 rupture in 424 deliveries. In 74 cases (77.1%) uterine rupture occurred after hospitalization, the remaining 22 cases being emergency transfers with rupture secondary to a delivery attempt elsewhere. History of a previous cesarean section was present in 46%, whereas 54% of the women had an unscarred uterus. Maternal mortality was 7.3% whilst perinatal mortality was 62.9%. Adverse outcome for the mother was associated with ruptures occurring in unscarred uteri (p < 0.02) and outside the Maternity (p < 0.01); this latter condition also contributed to higher fetal mortality (p < 0.002). The findings confirm that delay in reaching medical care is an aggravating factor in the evolution of uterine rupture in developing countries and suggest the need for better medical attention and timely diagnosis in laboring women with unscarred uterus.