Eze Justus Ndulue, Anozie Okechukwu Bonaventure, Lawani Osaheni Lucky, Ndukwe Emmanuel Okechukwu, Agwu Uzoma Maryrose, Obuna Johnson Akuma
Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria.
Department of Obstetrics and Gynaecology, Faculty of Medicine, Ebonyi State University, Abakaliki, Nigeria.
BMC Pregnancy Childbirth. 2017 Jun 8;17(1):179. doi: 10.1186/s12884-017-1367-8.
Uterine rupture is an obstetric calamity with surgery as its management mainstay. Uterine repair without tubal ligation leaves a uterus that is more prone to repeat rupture while uterine repair with bilateral tubal ligation (BTL) or (sub)total hysterectomy predispose survivors to psychosocial problems like marital disharmony. This study aims to evaluate obstetricians' perspectives on surgical decision making in managing uterine rupture.
A questionnaire-based cross-sectional study of obstetricians at the 46th annual scientific conference of Society of Gynaecology and Obstetrics of Nigeria in 2012. Data was analysed by descriptive and inferential statistics.
Seventy-nine out of 110 obstetricians (71.8%) responded to the survey, of which 42 (53.2%) were consultants, 60 (75.9%) practised in government hospitals and 67 (84.8%) in urban hospitals, and all respondents managed women with uterine rupture. Previous cesarean scars and injudicious use of oxytocic are the commonest predisposing causes, and uterine rupture carries very high incidences of maternal and perinatal mortality and morbidity. Uterine repair only was commonly performed by 38 (48.1%) and uterine repair with BTL or (sub) total hysterectomy by 41 (51.9%) respondents. Surgical management is guided mainly by patients' conditions and obstetricians' surgical skills.
Obstetricians' distribution in Nigeria leaves rural settings starved of specialist for obstetric emergencies. Caesarean scars are now a rising cause of ruptures. The surgical management of uterine rupture and obstetricians' surgical preferences vary and are case scenario-dependent. Equitable redistribution of obstetricians and deployment of medical doctors to secondary hospitals in rural settings will make obstetric care more readily available and may reduce the prevalence and improve the outcome of uterine rupture. Obstetrician's surgical decision-making should be guided by the prevailing case scenario and the ultimate aim should be to avert fatality and reduce morbidity.
子宫破裂是一种产科灾难，手术是其主要治疗手段。未行输卵管结扎的子宫修复术后子宫更容易再次破裂，而双侧输卵管结扎（BTL）或（次）全子宫切除术的子宫修复术会使幸存者面临婚姻不和等心理社会问题。本研究旨在评估产科医生在处理子宫破裂时的手术决策观点。
在2012年尼日利亚妇产科医师协会第46届年度科学会议上，对产科医生进行了一项基于问卷的横断面研究。数据采用描述性和推断性统计分析。
110名产科医生中有79名（71.8%）回复了调查，其中42名（53.2%）为顾问医生，60名（75.9%）在政府医院执业，67名（84.8%）在城市医院执业，所有受访者都处理过子宫破裂的妇女。既往剖宫产瘢痕和催产素使用不当是最常见的诱发原因，子宫破裂导致孕产妇和围产儿死亡率及发病率极高。38名（48.1%）受访者通常仅进行子宫修复，41名（51.9%）受访者进行子宫修复并同时行BTL或（次）全子宫切除术。手术管理主要依据患者情况和产科医生的手术技能。
尼日利亚产科医生的分布使得农村地区缺乏产科急症专科医生。剖宫产瘢痕现在是子宫破裂的一个日益增加的原因。子宫破裂的手术管理和产科医生的手术偏好各不相同，且取决于具体病例情况。公平重新分配产科医生并将医生部署到农村地区的二级医院将使产科护理更容易获得，并可能降低子宫破裂的发生率并改善其结局。产科医生的手术决策应以当前病例情况为指导，最终目标应是避免死亡并降低发病率。
