Aira Hospital

Ruptured uterus is caused by unrelieved obstructed labor. When the baby is too big and/or the pelvis too narrow, or when the baby lies in a wrong position, the delivery cannot proceed normally. The baby cannot be expelled in spite of strong contractions. After the laboring woman has suffered severe labor pain and pushed in vain for an extended period – sometimes up to several days – the uterus finally ruptures, and the child is delivered inside the abdominal cavity. The baby dies instantaneously, and often the mother as well after some time. If however the woman is brought alive to our hospital, we are able to save her life with emergency surgery in the vast majority of cases.

This condition is extremely rare – almost unheard of - in the western world where excellent obstetrical service is available everywhere and all around the clock. Unfortunately it is still very common here in Ethiopia where medical service and transportation is grossly insufficient. Often the woman has to be carried for up to 8 hours to get access to a car which can bring her to the hospital at great cost. The sad thing is that the car owners around the area often exploit the situation. Knowing that it is a matter of life or death they will demand incredible sums to take the patient to our hospital. Nothing is left for the hospital fee, and the expenses for a life saving treatment will have to be covered by the “poor fund”.

Usually the woman arrives in deep shock without pulse or blood pressure and has to be resuscitated with several liters of intravenous saline infusions before it is safe to give anesthesia. We repair the rupture in the vast majority of cases. Very rarely the uterus is removed, actually only in extreme cases when it would be technically more difficult and risky to repair. In five years it was only done twice with one survival. This is in dire contrast to the teaching in the university hospitals. There it is taught that leaving the uterus is extremely dangerous, and hysterectomy (removal of the uterus) is done as a routine - with a frightening high mortality. We think that adding a major surgical trauma to a patient already in critical condition, is contraindicated. With our principle of minimizing surgical trauma, the mortality is very low. About a year ago we revised our results, and found that the maternal mortality was only 3% - a survival rate of 97%.

Patient with ruptured uterus prepared for surgery	The rupture being sutured
The repair almost completed	The suction machine was out of order
Happy to be alive	Patient and husband before discharge
Three survivors with attendans	Two survivors with the surgeon

 

As mentioned above our surgical approach to uterine rupture is minimal surgery with repair of the rupture and thorough peritoneal lavage. We consider the routine use of hysterectomy as an unnecessary and harmful additional trauma to tissues already severely traumatized in a vulnerable and circulatory instable patient.

Only if hysterectomy is technically easier and faster than a repair, or if the uterus is in manifest gangrene is hysterectomy done. In 5 years that have been the case only twice.

The result of surgical management of uterine ruptures at Aira Hospital during the year 2006 at was given as a presentation at the international symposium of FIDE/DCT/DGCH in Jena November 2009.

Here is part of the presentation given:

 

 SURVIVAL RATE - a Power Point Presentation  ← click here

FIDE:  Frauengesundheit in der Entwicklungszusammenarbeit

DCT:  Deutsche Gesellschaft für Tropenchirurgie

DGCH: Deutsche Gesellschaft für Chirurgie