Management and Outcomes of Uterine Rupture in a Low-Resource Setting: A Case Series in Guyana
Introduction
Uterine rupture is a rare yet preventable complication in obstetrics that can have
severe consequences (Agrawal et al., 2023). It is defined as a complete tear through the uterine wall,
including the overlying serosa. In developed countries, the incidence of uterine rupture is
approximately 74 per 10,000 births
Objectives
To examine the clinical presentation, management, and outcomes of uterine rupture in a
low-resource setting in Guyana, providing insights for improved care strategies.
Method
Of 71,431 maternity patients treated at the Department of Obstetrics and Gynecology ,
Geor getown Public Hospital Corporation (GPHC), between 2012 and 2023, 12 cases of uterine
rupture were identified. Data on medical history , clinical presentation, and treatment approach were
systematically collected and analyzed, comparing outcomes with existing literature from both high-
and low-resource settings.
Results
The incidence of Uterine Rupture was 1.67 per 10000 deliveries, with a mean maternal age
of 33 years. Most patients were of mixed race and multiparous. The primary presenting symptoms
included abdominal pain (50%), vaginal bleeding (41.6%), and hemorrhagic shock (16.6%).
Diagnoses were mainly intraoperative (58.3%), while 25% were diagnosed preoperatively and
16.6% postpartum. Cesarean delivery was the most common mode of delivery (66.6%), often
performed for antepartum hemorrhage (41.6%). Of the cases, 5 involved scarred uteri and 7 were
unscarred uteri. Notably , of 85.7% of uterine rupture in unscarred uteri were associated with
induction of labour using misoprostol. Half of the patients were managed conservatively with
uterine repair , while the other half underwent abdominal hysterectomy . Maternal and fetal/neonatal
adverse outcomes were recorded in 83.3% and 75% of cases respectively .
Conclusion
Uterine rupture, although rare, remains a critical challenge in low-resource settings,
with high rates of adverse outcomes due to non-specific presentation and delayed diagnosis.
Strengthening emer gency obstetric care, early risk identification and diagnosis are essential to
improving prognosis in these settings.
17