During the study period, 64 cases of uterine rupture were recorded among 16,373 deliveries, representing a frequency of 0.39%. The mean age was 30.81 years (range: 17 - 45 years); 60.9% of patients were between 25 and 35 years old. The mean parity was 3 (range: 0 - 9). Multiparous women accounted for 37.5% of the sample, pauciparous women 29.7%, primiparous women 26.6%, and nulliparous women 6.3%. A scarred uterus was found in 58.0% of patients (Figure 1).

Figure 1. Distribution of patients according to uterine scar status.

Thirty-seven patients (57.8%) were referred from another health facility, whereas 27 (42.2%) were admitted directly. The main reasons for referral were labour in a scarred uterus (17.2%) and failure of engagement (10.9%). Only one patient was referred with a diagnosis of uterine rupture, while another was referred for impending uterine rupture syndrome (Figure 2). In contrast, 89.1% of the referred patients had already experienced uterine rupture at the time of admission to our department.

Term pregnancies accounted for 79.7% of cases, compared with 14.1% preterm and 6.3% post-term pregnancies. Fifty patients (78.1%) had attended at least four antenatal care visits, whereas 14 (21.9%) had attended one to three visits.

Pregnancy was singleton in 96.9% of cases. Fetal presentation was cephalic in 90.6%, breech in 6.3%, brow in 1.6%, and transverse in 1.6%.

Figure 2. Reasons for referral.

Clinical pelvimetry was considered normal in 70.3% of patients and abnormal in 29.7%.

At the time of rupture, 84.4% of patients were in labour. Labour began spontaneously in 78.1% of cases, labour was induced in 6.3%, and 15.6% underwent caesarean section before labour. Vaginal delivery occurred in 10.9% of patients, whereas fetal extraction was performed by laparotomy in 89.1%. Birth weight ranged between 2500 and 3499 g in 53.1% of cases (Table 1).

Table 1. Onset of labour, mode of delivery and birth weight.

Uterine rupture occurred during the latent phase in 51.6% of cases and during the active phase in 28.1%. Among patients not in labour (15.6%), rupture was discovered incidentally during a scheduled caesarean section for a scarred uterus. The timing of rupture was not documented in 4.7% of cases. Rupture involved the lower uterine segment in 59.4% of cases, was segmento-corporeal in 28.1%, and corporeal in 12.5%. Among patients with a previous uterine scar, 31 of 37 (83.3%) had a lower uterine segment rupture, compared with 7 of 27 (25.9%) among those with an unscarred uterus. The presence of a uterine scar was strongly associated with lower uterine segment rupture (OR = 14.76; 95% CI: 4.33 - 50.34; p = 0.0002). Complete rupture occurred in 73.4% of cases and incomplete (subserosal) rupture in 26.6%. Lesions were confined to the uterus in 78.1% of patients. Associated injuries were present in 21.9%: cervical (9.4%), vaginal (7.8%), and bladder (4.7%). No rectal injuries were observed.

Management was both medical and surgical. Conservative uterine repair was performed in 79.7% of patients, whereas hysterectomy was performed in 20.3%. Bladder, cervical, and vaginal injuries were repaired when present. Thirty-seven patients (57.8%) with severe hemorrhage and hemodynamic compromise were admitted to the intensive care unit and received fluid resuscitation, blood transfusion, and oxygen therapy. The main maternal complications were acute anemia (57.8%), acute kidney injury (10.9%), and postoperative infection (6.3%). Maternal and fetal mortality were assessed in the short and medium term during the hospital stay. Three maternal deaths were recorded, corresponding to a case-fatality rate of 4.7% among patients with uterine rupture; two of these deaths were associated with placental abruption and coagulopathy. Fetal mortality was 34.4% (n = 23) among the 67 births, including 4.5% macerated stillbirths. All fresh stillbirths occurred in patients with complete uterine rupture (p = 0.0001) (Table 2).

Table 2. Maternal management and maternal and fetal outcomes.

The frequency observed (0.39%) confirms that uterine rupture remains an uncommon obstetric complication among all deliveries, although it is considerably more frequent than that reported in high-income countries [3][9][10]. However, comparisons should take into account the referral level of healthcare facilities, the definitions used, and the proportion of referred patients. Higher frequencies have been reported in several sub-Saharan African series, particularly from Mali, Guinea, Madagascar, and Nigeria [5][11]-[14]. The referral-center status of the CHNP, delays in patient transfer, and difficulties in intrapartum monitoring may have contributed to the observed frequency, as 89.1% of referred patients had already experienced uterine rupture at the time of admission to our department. The predominance of women aged 25 - 35 years reflects the period of highest reproductive activity. Multiparity, frequently reported in African series, may increase exposure to obstructed labour and repeated use of uterotonic agents; however, it should not be interpreted in isolation as a causal factor [5][11][15]. Associations between maternal age, parity, and uterine rupture were not formally tested in our analysis and should therefore be interpreted with caution. The high proportion of referred patients (57.8%) is consistent with findings from African studies, where uterine rupture is commonly managed in referral hospitals following delayed transfer [5][11][12]. This highlights the importance of early recognition of labour dystocia, effective communication between healthcare facilities, and the availability of medical transport. Most uterine ruptures occurred in women with a previous uterine scar (58.0%), in contrast to older African studies in which rupture of an unscarred uterus predominated [5][13][14]. This trend may reflect the increasing caesarean section rate and, consequently, the growing number of pregnant women with a uterine scar. In this group, the choice of mode of delivery should be individualized, and a trial of labour should only be undertaken in facilities capable of performing immediate caesarean delivery and advanced maternal resuscitation [16][17]. Rupture of an unscarred uterus remains exceptional in high-income countries but continues to be of particular concern in settings where prolonged obstructed labour, delays in management, and inappropriate use of oxytocin or prostaglandins persist [10][18]. Nevertheless, the low induction rate observed in our series does not allow any causal relationship to be established. The reduced biomechanical strength of scar tissue constitutes the pathophysiological basis for the risk of uterine scar dehiscence or rupture during labour [19].

Although 78.1% of women attended at least four antenatal care visits, information regarding the quality, content, and timing of these visits was unavailable. Therefore, the number of antenatal visits alone is insufficient to assess the quality of antenatal care. The World Health Organization recommends a minimum of eight antenatal contacts to improve the detection of pregnancy complications and women’s overall pregnancy experience [20]. The high proportion of cephalic presentations also indicates that uterine rupture was not limited to dystocic presentations. Antenatal identification of risk factors, early recognition of labour dystocia, and development of an individualized birth plan are particularly important for women with a previous uterine scar. Nevertheless, uterine rupture may occur in the absence of obvious predictive factors; therefore, close intrapartum clinical monitoring and rapid access to emergency surgery remain essential [16][17]. Labour was spontaneous in the majority of cases. Induction or augmentation of labour after a previous caesarean section may increase the risk of uterine rupture depending on the induction method and the clinical context [21]-[23]. These interventions should follow standardized protocols, with continuous maternal and fetal monitoring and immediate access to surgical intervention. Suspected or confirmed uterine rupture requires emergency laparotomy combined with maternal haemodynamic resuscitation, fetal extraction, and haemorrhage control. The choice between conservative uterine repair and hysterectomy depends on the extent of uterine injury, maternal haemodynamic status, future fertility wishes, and the surgical team’s experience [1][2][24]. In our series, diagnosis following vaginal delivery in 10.9% of patients highlights the importance of considering uterine rupture in cases of unexplained postpartum haemorrhage or maternal shock.

The predominance of complete ruptures (73.4%) and lower uterine segment injuries (59.4%) is comparable to findings from numerous African hospital-based studies [5][11]-[14]. The association between lower segment rupture and a scarred uterus is anatomically plausible since most caesarean section scars are located in the lower uterine segment. Segmento-corporeal extension and associated cervical, vaginal, or bladder injuries may indicate advanced uterine rupture and delayed management. These lesions increase surgical complexity, transfusion requirements, and the risk of maternal morbidity [1][2][24]. Conservative uterine repair was performed in 79.7% of cases, whereas the multicentre Senegalese study by Cissé et al. historically reported a higher proportion of radical surgery [4]. This trend toward uterine preservation has also been described in more recent Senegalese and West African studies [7][8][25]. However, conservative management remains dependent on achieving adequate haemostasis and the absence of irreparable uterine damage. Optimal management requires a multidisciplinary team, rapid access to blood products, anaesthesia and intensive care services, and, when urological injuries are present, appropriate surgical expertise. Limited blood supply and delays in referral remain major challenges in resource-limited healthcare systems [5][11][12].

The maternal case fatality rate of 4.7% and fetal mortality rate of 34.4% remain high despite improvements compared with several older African studies [4][5][11]-[14]. Acute anaemia was the most frequent maternal complication, emphasizing the predominantly haemorrhagic nature of this obstetric emergency. The observed association between complete uterine rupture and fresh stillbirth confirms the severe fetal consequences of full-thickness uterine rupture. In high-income countries, maternal mortality is exceptional; however, uterine rupture remains associated with severe maternal morbidity and a substantial risk of perinatal hypoxia and death [3][9][10].

This study provides recent data from a referral hospital located in the suburbs of Dakar. However, its retrospective design exposes it to missing data and information bias. As a single-centre hospital-based study, the findings cannot be generalized to the entire Senegalese population. Furthermore, the absence of a control group precludes the identification of independent risk factors. Finally, referral delays, detailed information on uterotonic use, the quality of antenatal care, and early neonatal outcomes were insufficiently documented.