Journal of Obstetrics and Gynaecology

ISSN: 0144-3615 (Print) 1364-6893 (Online) Journal homepage: http://www.tandfonline.com/loi/ijog20

High rate of uterine rupture in a conflict setting of

Hajjah, Yemen

Abdullah A. Al-Rukeimi, Ahmed Al-Haddad, AbdelAziem A. Ali & Ishag Adam

To cite this article: Abdullah A. Al-Rukeimi, Ahmed Al-Haddad, AbdelAziem A. Ali & Ishag Adam
(2017): High rate of uterine rupture in a conflict setting of Hajjah, Yemen, Journal of Obstetrics and
Gynaecology, DOI: 10.1080/01443615.2017.1324412

To link to this article: http://dx.doi.org/10.1080/01443615.2017.1324412

Published online: 01 Aug 2017.

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Download by: [Tufts University] Date: 01 August 2017, At: 03:06

JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 2017
https://doi.org/10.1080/01443615.2017.1324412

SHORT COMMUNICATION

High rate of uterine rupture in a conflict setting of Hajjah, Yemen

Abdullah A. Al-Rukeimia,b, Ahmed Al-Haddada, AbdelAziem A. Alic and Ishag Adamd
a
Faculty of Medicine, Sana'a University, Sana’a, Yemen; bDepartment of Obstetrics and Gynecology, Saudi Hospital, Hajjah, Yemen;
c
Department of Obstetrics and Gynaecology, Kassala University, Kassala, Sudan; dDepartment of Obstetrics and Gynecology, Faculty of
Medicine, University of Khartoum, Khartoum, Sudan

ABSTRACT KEYWORDS
A descriptive study was conducted to investigate the epidemiology and the outcome of uterine rupture Ruptured uterus; maternal
at Hajjah Hospital, Yemen, during September 2014–August 2016. There were 110 cases of ruptured ute- death; delivery; Yemen
rus and 3457 deliveries (31.8 per 1000 delivery). The majority (82, 74.5%) of these patients were illiter-
ate. One hundred and four (96.3%) of them had no antenatal care. Seventy-eight of these women
(70.9%) delivered at home and 32 (29.1%) delivered at hospital. Out of these 110 cases, 74 (67.3%) and
36 (32.7%) had unscarred uterus and scarred uterus, respectively. The causes of ruptured uterus were
as follows: obstructed labour 59 (53.6%), previous caesarean delivery 36 (32.7%), use of oxytocin 10
(9.1%) and misoprostol 5 (4.6%). Hysterectomy was carried out in 50 (45.4%) %), repair in 39 (35.4%),
repair with tubal ligation in 18 (16.4%) patients and 3 (2.7%) patients died before operation. There was
8 (7.2%) and 101 (91.8%) maternal and perinatal mortality, respectively. Nineteen (17.3%), 6 (5.4%) and
2 (1.8%) women developed sepsis, had urinary bladder injury and developed vesicovaginal fistulae,
respectively.

Introduction Results and discussion

Uterine rupture remains a public health problem in develop-
ing countries (Diab 2005; Ali and Adam 2011) where it signifi-
cantly contributes to maternal and perinatal mortality, e.g. it
accounts for 14.19% of maternal deaths in Yemen (Dhaifalah
et al. 2006). Due to the ongoing armed conflict, Yemen’s –
already fragile – health system has come under enormous
pressure. The armed conflict with continuous fighting has
destroyed health system infrastructures and increased the
strain on the health facilities that are still functioning
(Aladhrai et al. 2015). The ongoing conflict might have an
impact on obstetrics care with its indicators, e.g. increase the
rate of rupture uterus.
Materials and methods
A descriptive study was conducted to investigate the inci-
dence, causes and maternal, perinatal outcome of uterine
rupture, defined as complete separation of uterine wall
thickness involving the serosa
28-week gestation, at
Hajjah Hospital, Yemen, during September 2014–August
2016. After signing an informed consent; obstetric, peri-
natal and maternal outcomes were gathered using ques-
tionnaires. Ethical clearance was received from the ethics
committee of the hospital.
SPSS for Windows (version 20.0) (SPSS Inc., Chicago, IL)
was used for data analyses. Means and proportions were
compared between the different groups using t-test and X2,
respectively. p < .05 was considered significant.
There were 110 cases of ruptured uterus and 3457 deliveries
(31.8 per 1000 delivery) which is higher compared with
the past report from the same hospital (37/588 [0.64%) vs.
110/3457 [3.1%], p < .001) and different setting, e.g. 2.0% in
Sudan and 0.9% in Ethiopia (Ali and Adam 2011; Berhe et al.
2015).
The mean (SD) of the age and parity was 29.5 (5.4) years
and 4.8 (1.7), respectively. The majority (82, 74.5%) of these
patients were illiterate. Two-third were of rural residence (66,
60%), and the vast majority had no antennal care (104,
96.3%). Seventy-eight of these women (70.9%) delivered at
home, 32 (29.1%) delivered at hospital, and 27 (84.3%) of
them started the labour at home. Postpartum haemorrhage
(71, 64.5%) was the main presentation among these women.
Out of these 110 cases, 74 (67.3%) and 36 (32.7%) had
unscarred uterus and scarred uterus, respectively.
The causes of ruptured uterus were as follows: obstructed
labour 59 (53.6%), previous caesarean delivery 36 (32.7%), use
of oxytocin 10 (9.1%) and misoprostol 5 (4.6%). Hysterectomy
(difficult to repair) was carried out in 50 (45.4%), repair in 39
(35.4%), repair with tubal ligation in 18 (16.4%) patients and
3 (2.7%) patients died before operation. All the patients
received blood transfusion.
There was 8 (7.2%) and 101 (91.8%) maternal and perinatal
deaths, respectively. Shock was the cause of seven (87.5) of
the eight maternal deaths and one (12.5) woman died
because of sepsis. Nineteen (17.3%), 6 (5.4%) and 2 (1.8%)
women developed sepsis, had urinary bladder injury and

CONTACT Abdullah A. Al-Rukeimi gasimgsm1974@gmail.com Faculty of Medicine, Sana'a University, Sana’a, Yemen
ß 2017 Informa UK Limited, trading as Taylor & Francis Group
2 A. A. AL-RUKEIMI ET AL.

Table 1. Comparison in socio-demographic and obstetric characteristics optimising the caesarean rate might help in reducing the rate
between those who died and survived due to uterine rupture at Hajjah
Hospital, Yemen.
of uterine rupture. It might be difficult to implement these
Variables Dead women (n ¼ 8) Survived (n ¼ 102) p-Value
measures during the ongoing conflict.
Age 29 (5.5) 30 (5.1) .429
Rural residence 7 (87.5) 59 (57.8) .002
Illiteracy 5 (62.5) 71 (69.6) .891 Disclosure statement
Lack of prenatal care 7 (87.5) 97 (93.2) .233
High parity (
5) 2 (25.0) 26 (25.4) .532 No potential conflict of interest was reported by the authors.
Home delivery 8 (100.0) 70 (68.6) .041
Data were shown as mean (SD) and number (%) as applicable.
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