Alemu Addisu, Yadeta Elias, Deressa Alemayehu, Debella Adera, Birhanu Abdi, Heluf Helina, Mohammed Ahmed, Ahmed Fila, Beyene Andinet, Getachew Tamirat, Eyeberu Addis
School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Int J Womens Health. 2023 Mar 25;15:443-453. doi: 10.2147/IJWH.S402885. eCollection 2023.
Uterine rupture is the most dangerous complication of labor and contributes to high maternal mortality. Despite efforts to improve basic and comprehensive emergency obstetric treatment, women continue to suffer from disastrous maternal outcomes.
This study aimed to assess the survival status and predictors of mortality among women with uterine rupture at public hospitals in the Harari Region, Eastern Ethiopia.
We conducted a retrospective cohort study among women with uterine rupture in public hospitals in Eastern Ethiopia. All women with uterine rupture were followed for 11 years retrospectively. Statistical analysis was conducted with STATA version 14.2. Kaplan-Meier curves together with a Log rank test were used to estimate the survival time and show the presence of differences among groups. Cox Proportion Hazard (CPH) model was used to determine the association between independent variables and survival status.
There were 57,006 deliveries in the study period. We found that 10.5% (95% CI: 6.8-15.7) of women with uterine rupture have died. The median recovery and death time for women with uterine rupture were 8 and 3 days with interquartile range (IQR) of 7-11 days and 2-5 days, respectively. Antenatal care follow-up (AHR: 4.2, 95% CI: 1.8-9.79), education status (AHR: 0.11; 95% CI: 0.02-0.85), visiting health center (AHR: 4.89; 95% CI: 1.05-22.88), and admission time (AHR: 4.4; 95% CI: 1.89-10.18) were the predictors of survival status of women with uterine rupture.
One out of ten study participants died due to uterine rupture. Factors including not having ANC follow-up, visiting health centers for treatment, and being admitted during the night time were predictors. Thus, a great emphasis has to be given to the prevention of uterine rupture and the linkage within health institutions has to be smooth to improve the survival of patients with uterine rupture with the help of different professionals, health institutions, health bureaus, and policymakers.
子宫破裂是分娩最危险的并发症，会导致孕产妇高死亡率。尽管一直在努力改善基本和全面的产科急诊治疗，但女性仍遭受灾难性的孕产妇结局。
本研究旨在评估埃塞俄比亚东部哈勒尔地区公立医院子宫破裂女性的生存状况及死亡预测因素。
我们对埃塞俄比亚东部公立医院子宫破裂女性进行了一项回顾性队列研究。对所有子宫破裂女性进行了11年的回顾性随访。使用STATA 14.2版进行统计分析。采用Kaplan-Meier曲线和对数秩检验来估计生存时间并显示组间差异。使用Cox比例风险（CPH）模型确定自变量与生存状况之间的关联。
研究期间共有57006例分娩。我们发现10.5%（95%可信区间：6.8 - 15.7）的子宫破裂女性死亡。子宫破裂女性的中位康复时间和死亡时间分别为8天和3天，四分位间距（IQR）分别为7 - 11天和2 - 5天。产前检查随访（风险比：4.2，95%可信区间：1.8 - 9.79）、教育状况（风险比：0.11；95%可信区间：0.02 - 0.85）、就诊于健康中心（风险比：4.89；95%可信区间：1.05 - 22.88）以及入院时间（风险比：4.4；95%可信区间：1.89 - 10.18）是子宫破裂女性生存状况的预测因素。
十分之一的研究参与者死于子宫破裂。包括未进行产前检查随访、到健康中心就诊治疗以及夜间入院等因素是预测因素。因此，必须高度重视子宫破裂的预防，卫生机构之间的联系必须顺畅，以便在不同专业人员、卫生机构、卫生局和政策制定者的帮助下提高子宫破裂患者的生存率。
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