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Outside of Senegal Hospital
Senegal Hospital

Tearing of the uterus is a serious complication in pregnancy that can lead to bleeding, shock and even death. Uterine rupture is very rare in the United States but is more common in low-income nations. A study from University of Hawaiʻi at Mānoa public health researchers that examined data from two countries in West Africa shows that women whose labor slows down or stops altogether, resulting in the need to be transferred to a higher-level hospital, are at increased risk of uterine rupture.

Researchers led by Rebecca Delafield, a PhD student with the Office of Public Health Studies in the Myron B. Thompson School of Social Work, looked at data from the medical records of nearly 85,000 women who gave birth over the course of one year in Senegal and Mali. The researchers found that 569 of the women had suffered a uterine rupture while giving birth.

“The fact that uterine rupture is so rare in high-income nations demonstrates that it is largely preventable,” said Delafield. “We wanted to find out what increases the risk of suffering a uterine rupture for women. A better understanding of the factors involved could point to ways to prevent this outcome and possibly save lives.”

Obstructed labor strong predictor of uterine rupture

The data showed that the likelihood of a woman experiencing a uterine rupture increased with the number of times she had given birth. Women in the sample who had given birth five or more times were nearly eight times more likely to suffer a uterine rupture compared with women who had given birth once.

But the strongest single factor that influenced a woman’s risk of uterine rupture was “obstructed labor,” meaning that her labor had slowed down or stopped.

“We were not surprised to see obstructed labor was a strong predictor of uterine rupture,” Delafield said. “But what this study also shows is that, in addition to obstetric factors, health system factors increase the likelihood of uterine rupture in this population.”

The women in the study who had obstructed labor and were transferred to a higher-level hospital were 46 times more likely to experience a uterine rupture compared with women who did not have obstructed labor and did not need to be referred to the higher-level hospitals.

Findings support health-system improvements

Said Delafield, “Our findings suggest that women would benefit from improvements in the health systems in these settings. By improving the quality of care at the smaller, local hospitals or by transferring patients with obstructed labor more quickly, women might receive the care they need in time to prevent uterine rupture.”

The study was published November 1 in the journal BMC Pregnancy and Childbirth. Delafield’s co-authors include Catherine Pirkle, an assistant professor with the UH Office of Public Health Studies, and Alexandre Dumont, a researcher at the Research Institute for Development in Marseille, France.

—By Theresa Kreif

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