title: Posterior uterine rupture secondary to use of herbs leading to peritonitis and maternal death in a primigravida following vaginal delivery of a live baby in western Uganda: a case report.
abstract: Uterine rupture is a potentially avoidable complication resulting in poor perinatal and maternal outcomes. This case had a number of unusual features including delivery of a healthy live baby; spontaneous posterior uterine rupture in a primigravida (and unscarred uterus); and delayed presentation with signs of peritonitis and sepsis rather than haemorrhage. A 19-year old primigravida had a vaginal delivery of a live infant at term, reporting having taken herbs to induce labour. She deteriorated and was transferred to our unit where she was found to have reduced consciousness, a distended abdomen and signs of sepsis. At laparotomy there was blood-stained ascites, signs of peritonitis and a posterior lower segment uterine rupture. A sub-total hysterectomy was performed but the patient's condition worsened resulting in maternal death 5 days post-operatively. This case highlights a number of differences in the presentation, management and outcomes of uterine rupture in resource-poor compared to resource-rich countries.
authors.affiliation: Fort Portal Regional Referral Hospital, Fort Portal, Uganda.
authors.forename: Jonathan Peter
authors.initials: JP
authors.lastname: Nelson
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000009:adverse effects; D063130:Maternal Death; D016488:Medicine, African Traditional / Q000009:adverse effects / Q000379:methods; D010538:Peritonitis / Q000139:chemically induced*; D028321:Plant Preparations / Q000008:administration & dosage / Q000009:adverse effects*; D011247:Pregnancy; D018805:Sepsis / Q000209:etiology; D014454:Uganda; D014597:Uterine Rupture / Q000139:chemically induced*; D055815:Young Adult
chemical_list: D028321:Plant Preparations
keywords: Maternal death; global health; herbal medicines; maternal health; uterine rupture