title: A two-year review of uterine rupture in a regional hospital.
abstract: BACKGROUND
  Uterine rupture causes high maternal and neonatal mortality in many rural setting in the world. Further studies might provide specific interventions to reduce the high prevalence.
  
  
  OBJECTIVE
  To determine the frequency, causes, clinical presentation, management and outcome of uterine rupture
  
  
  METHODS
  Department of Obstetrics and Gynaecology, Upper West Regional Hospital, Wa, Ghana.
  
  
  METHODS
  Retrospective descriptive study.
  
  
  METHODS
  A descriptive study of cases of ruptured uterus in the Regional Hospital from 1st January, 2007 to 31st December 2008 was done. A structured questionnaire was developed to collate data from various registers for analysis.
  
  
  RESULTS
  Total deliveries were 5085 with 4172(82%) spontaneous vaginal delivery and 911(17.9%) caesarean sections. Uterine rupture occurred in 41 cases for a ratio of 1:124 Grand multipara with five or more deliveries represented 41.5% while those with two prior successful deliveries represented 31.7%. The mean parity was 3.8 (SD 2.3) under antenatal care, 85.4% had at least four visits. Severe anaemia 28(68.3%) and abdominal tenderness 27(65.8%) were the most frequent clinical presentation while the use of local herbal concoction with suspected uterotonic activity 24(58.5%), fetopelvic disproportion 4 (9.8%) and malpresentation 5(12.1%) were the most significant causes. Major complications were: neonatal deaths 34(82.9%), maternal mortality 4(9.8%) and wound infections 15 (36.6%). Subtotal hysterectomy 10(24.4%) and total hysterectomy 18(43.8%) were preferred to uterine repair 12(23.3%) and 87.8% required at least two units of blood transfusion.
  
  
  CONCLUSIONS
  skilled attendance with accessible emergency obstetric care and focused antenatal care are key elements for the prevention and management of uterine rupture.
authors.affiliation: Ghana Health Service, Regional Hospital, Wa, Upper West Region, Ghana.
authors.forename: Co
authors.initials: C
authors.lastname: Fofie
authors.forename: P
authors.initials: P
authors.lastname: Baffoe