Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
PLoS One. 2021 Apr 22;16(4):e0245977. doi: 10.1371/journal.pone.0245977. eCollection 2021.
Uterine rupture is the leading cause of maternal and perinatal morbidity and it accounts for 36% of the maternal mortality in Ethiopia. The maternal and perinatal outcomes of uterine rupture were inconclusive for the country. Therefore, this systematic review and meta-analysis aimed to estimate the pooled maternal and perinatal mortality and morbidity of uterine rupture and its association with prolonged duration of operation.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used for this systematic review and meta-analysis. We systematically used PubMed, Cochrane Library, and African Journals online databases for searching. The Newcastle- Ottawa quality assessment scale was used for critical appraisal. Egger's test and I2 statistic used to assess the check for publication bias and heterogeneity. The random-effect model was used to estimate the pooled prevalence and odds ratios with 95% confidence interval (CI).
The pooled maternal mortality and morbidity due to uterine rupture in Ethiopia was 7.75% (95% CI: 4.14, 11.36) and 37.1% (95% CI: 8.44, 65.8), respectively. The highest maternal mortality occurred in Southern region (8.91%) and shock was the commonest maternal morbidity (24.43%) due to uterine rupture. The pooled perinatal death associated with uterine rupture was 86.1% (95% CI: 83.4, 89.9). The highest prevalence of perinatal death was observed in Amhara region (91.36%) and the lowest occurred in Tigray region (78.25%). Prolonged duration of operation was a significant predictor of maternal morbidity (OR = 1.39; 95% CI: 1.06, 1.81).
The percentage of maternal and perinatal deaths due to uterine rupture was high in Ethiopia. Uterine rupture was associated with maternal morbidity and prolonged duration of the operation was found to be associated with maternal morbidities. Therefore, birth preparedness and complication readiness plan, early referral and improving the duration of operation are recommended to improve maternal and perinatal outcomes of uterine rupture.
子宫破裂是孕产妇和围产儿发病率的主要原因，占埃塞俄比亚孕产妇死亡率的 36%。该国的子宫破裂的孕产妇和围产儿结局尚无定论。因此，本系统评价和荟萃分析旨在估计子宫破裂的汇总孕产妇和围产儿死亡率和发病率，及其与手术时间延长的关系。
本系统评价和荟萃分析使用了《系统评价和荟萃分析首选报告项目》清单。我们系统地使用 PubMed、Cochrane 图书馆和非洲期刊在线数据库进行搜索。使用纽卡斯尔-渥太华质量评估量表进行批判性评估。使用 Egger 检验和 I2 统计量评估发表偏倚和异质性检查。使用随机效应模型估计汇总患病率和比值比，并带有 95%置信区间（CI）。
埃塞俄比亚子宫破裂导致的孕产妇死亡率和发病率分别为 7.75%（95% CI：4.14，11.36）和 37.1%（95% CI：8.44，65.8）。南部地区的孕产妇死亡率最高（8.91%），子宫破裂导致的常见的孕产妇并发症是休克（24.43%）。与子宫破裂相关的围产儿死亡的汇总率为 86.1%（95% CI：83.4，89.9）。在阿姆哈拉地区观察到的围产儿死亡发生率最高（91.36%），而在提格雷地区最低（78.25%）。手术时间延长是孕产妇发病率的一个显著预测因素（OR = 1.39；95% CI：1.06，1.81）。
埃塞俄比亚因子宫破裂导致的孕产妇和围产儿死亡比例较高。子宫破裂与孕产妇发病率有关，且手术时间延长与孕产妇发病率有关。因此，建议制定生育准备和并发症准备计划、及早转诊以及改善手术时间，以改善子宫破裂的孕产妇和围产儿结局。
