<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article  PUBLIC "-//NLM//DTD Journal Publishing DTD v3.0 20080202//EN" "http://dtd.nlm.nih.gov/publishing/3.0/journalpublishing3.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="3.0" xml:lang="en" article-type="research article"><front><journal-meta><journal-id journal-id-type="publisher-id">OJOG</journal-id><journal-title-group><journal-title>Open Journal of Obstetrics and Gynecology</journal-title></journal-title-group><issn pub-type="epub">2160-8792</issn><publisher><publisher-name>Scientific Research Publishing</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.4236/ojog.2019.94051</article-id><article-id pub-id-type="publisher-id">OJOG-92032</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine&amp;Healthcare</subject></subj-group></article-categories><title-group><article-title>
 
 
  Uterine Rupture: Epidemiological Aspects, Etiologies and Maternal-Fetal Prognosis in the Obstetric Gynecology Department of the Donka CHU Conakry National Hospital, Guinea
 
</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Boubacar</surname><given-names>Siddi Diallo</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Ibrahima</surname><given-names>Sory Balde</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Ibrahima</surname><given-names>Conte</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Ousmane</surname><given-names>Balde</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Ibrahima</surname><given-names>Sylla</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Abdourahmane</surname><given-names>Diallo</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Oumou</surname><given-names>Hawa Bah</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Loua</surname><given-names>Avit</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Telly</surname><given-names>Sy</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Namory</surname><given-names>Keita</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Mamadou</surname><given-names>Hady Diallo</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib></contrib-group><aff id="aff2"><addr-line>University Department of Gynecology-Obstetrics, Ignace Deen National Hospital, Conakry, Guinea</addr-line></aff><aff id="aff1"><addr-line>University Department of Gynecology-Obstetrics, Donka National Hospital, Conakry, Guinea</addr-line></aff><pub-date pub-type="epub"><day>29</day><month>03</month><year>2019</year></pub-date><volume>09</volume><issue>04</issue><fpage>521</fpage><lpage>528</lpage><history><date date-type="received"><day>28,</day>	<month>March</month>	<year>2019</year></date><date date-type="rev-recd"><day>22,</day>	<month>April</month>	<year>2019</year>	</date><date date-type="accepted"><day>25,</day>	<month>April</month>	<year>2019</year></date></history><permissions><copyright-statement>&#169; Copyright  2014 by authors and Scientific Research Publishing Inc. </copyright-statement><copyright-year>2014</copyright-year><license><license-p>This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/</license-p></license></permissions><abstract><p>
 
 
  Objectives:
   The objectives of this work were to calculate the frequency of the uterine rupture, to describe the epidemiological profile, to identify the etiologies and to establish the maternal prognosis and f
  oe
  tal. <b>Methodology</b>: It was about a descriptive survey with compilation of the data in two phases: a retrospective spreading on one period of 6 years and the other forecasting of 1 one year achieved to the service of Obstetric Gynecology of the hospital National Donka
  ,
   Fallen from Conakry
  ,
   Guinea.
   
  <b>Results:</b>
   We recorded 24.030 childbirths of which 188 cases of uterine rupture either a frequency of 0.78, which represents an uterine rupture for 128 childbirths. The epidemiological profile was the one of a woman of 24 to 28 years (31.91%), housewives (69.14%), without prenatal follow-up (47.87%), big multipare
   
  (37.76%) and &#233;vacu&#233;es
   
  (78.78%). The motives of consultation have been dominated by the h&#233;morragie
   
  (95.74%). The rupture was of transverse type in the majority of the cas
  e 
  (63.82%). The hysterorraphy was the most performed surgical procedure 
  which 
  is 85.10% followed by the total sub hysterectomy in 10.63%. The newborns of birth weight superior or equal to 4000
   
  g represent 25.53%. The maternal morbidity has been dominated by the anemia of the postpartum
   
  (60%). We recorded a rate of maternal l&#233;talit&#233; of 12.76%. The maternal deaths were due to the hemorrhage in 78.57%. The living newborns endured a respiratory distress in 9.57% and those stillborn represent 87.23%. The etiologies of uterine rupture were dominated by fetal-pelvic disproportions 48.93% followed by an iatrogenic uterine rupture 22.33%. <b>Conclusion:</b> The reduction of this uterine rupture rate would pass by the recentered prenatal consultation offer
  ed
  , the one of obstetric cares and complete n&#233;onataux of emergency, the discount to level of the beneficiaries of the basic structures so that they can discover the cases in time susceptible to drag a rupture to evacuate better in time and the promptness in the hold in charge since the admission of the emergencies in the structures of superior level.
 
</p></abstract><kwd-group><kwd>Uterine Rupture</kwd><kwd> Etiologie</kwd><kwd> Prognosis</kwd></kwd-group></article-meta></front><body><sec id="s1"><title>1. Introduction</title><p>The uterine rupture is an obstetric emergency defined like a solution of surgical, interesting continuity one or all tunics of the uterus, structural on the body and/or the lower segment of the uterus to the exclusion of the rips limited to the collar, the wounds by abdominal traumatism and perforations by abortive manœuvres [<xref ref-type="bibr" rid="scirp.92032-ref1">1</xref>] . Several studies done in the world were permitted to note today that in the countries highly m&#233;dicalis&#233;s, the uterine rupture became exceptional especially occurring on the uteruses weakened by scars of previous interventions [<xref ref-type="bibr" rid="scirp.92032-ref2">2</xref>] . On the other hand in Africa Sub-Of the Sahara, the rupture of healthy uterus stays the main met anatomo-clinical shape; most occurring at the parturientes presenting a childbirth dystocia [<xref ref-type="bibr" rid="scirp.92032-ref3">3</xref>] . Indeed, in spite of the important progress recorded in the setting of the program of reduction of mortality and morbidity materno-fœtale, the women in the underequipped countries continue to pay a heavy tribe to the complications bound to pregnancy and the childbirth. Among these complications, uterine rupture is one of the most serious since it immediately brings the maternal and fetal vital prognosis into interaction [<xref ref-type="bibr" rid="scirp.92032-ref4">4</xref>] . The frequency of the uterine rupture is variable from a country to the other: to the United States, his/her/its impact varies between 1/1000 and 1/1500 accouchements [<xref ref-type="bibr" rid="scirp.92032-ref5">5</xref>] . In France, it is located between 1/1000 and 1/1200 [<xref ref-type="bibr" rid="scirp.92032-ref6">6</xref>] . To Morocco, a hospitable survey achieved in 3 years revealed a frequency of 0.3% [<xref ref-type="bibr" rid="scirp.92032-ref7">7</xref>] . The frequency of the uterine rupture in Africa Sub-Of the Sahara varies from 0.89% to Mali to 4.04% to Niger [<xref ref-type="bibr" rid="scirp.92032-ref8">8</xref>] [<xref ref-type="bibr" rid="scirp.92032-ref9">9</xref>] . In Guinea, a hospitable survey achieved in Conakry gives like frequency 0.98% (36 uterine ruptures for 3663 childbirths) [<xref ref-type="bibr" rid="scirp.92032-ref10">10</xref>] . The prognosis of this affection is serious, 13% to 26% of maternal mortality and 75% to 90% of mortality fœtale in the countries underdeveloped [<xref ref-type="bibr" rid="scirp.92032-ref9">9</xref>] .</p><p>The objectives of this work were to calculate the frequency of the uterine rupture, to describe the epidemiological profile, to identify the etiologies and to establish the maternal prognosis and fœtal.</p></sec><sec id="s2"><title>2. Methodology</title><p>It was about a descriptive survey with compilation of the data in two phases: a retrospective spreading on one period of 6 years and the other forecasting of one year achieved to the service of Obstetric Gynecology of the hospital National Donka, Fallen from Conakry.</p><p>Have been included in this survey all cases of uterine ruptures evacuated in the service or the uterine ruptures occurred during the work of childbirth in the same service.</p><p>Have been excluded all cases of uterine ruptures intervening and taken in charge outside of the service and admitted for the complications following these holds in charge.</p><p>The studied variables were epidemiological (maternal age, prenatal follow-up, gestit&#233;, parity, profession, the level of instruction, the statute matrimonial), cliniques (mode of admission, state of the uterus, motive of consultation, surgical gestures, weight of birth, maternal morbidity, maternal l&#233;talit&#233;, reasons of maternal death, l&#233;talit&#233; fœtale) et &#233;tiologiques.</p></sec><sec id="s3"><title>3. Results</title><p>Frequency: We recorded 24.030 childbirths of which 188 cases of uterine rupture either a frequency of 0.78, what represents an uterine rupture for 128 childbirths.</p><sec id="s3_1"><title>3.1. Epidemiology</title><p>- Age: The age group of 24 to 28 years is the more concerned 31.91%. The middle age was of 28 years with extremes of 14 and 42 years</p><p>- Profession: The housewives were more concerned with 69.14%.</p><p>- Prenatal follow-up: The patients without prenatal follow-up represented 47.87%.</p><p>- Parity: The big multiparous with 37.76% were the more touched. The middle parity was of 8.95.</p></sec><sec id="s3_2"><title>3.2. Clinic</title><p>- Fashion of admission: The evacuees constituted 78.78% of the received patients.</p><p>- Circumstance of discovery: The hemorrhages constituted the main circumstance of discovery in case of cicatricial uterus either 95.74% against 88% on non cicatricial uterus.</p><p>- Aspect of the uterus: The features of rupture were Transverse in 63.82% of the cases.</p><p>- Surgical gestures: The hysterorraphie was the surgical gesture the more practiced either 85.10% follow-up of the hysterectomy total sub in 10.63%.</p><p>- Weight of birth: The newborns of birth weight superior or equal to 4000 g represent 25.53%.</p><p>- Maternal morbidity: The maternal morbidity has been dominated by the anemia of the postpartum (60%).</p><p>- Maternal L&#233;talit&#233;: We recorded a rate of maternal l&#233;talit&#233; of 12.76%.</p><p>- Reasons of maternal death: The maternal deaths were due to the hemorrhage in 78.57%.</p><p>- Morbidity fœtale: In our set, 18 newborns endured a respiratory distress is 9.57% of the cases among which 6 survived after a resuscitation.</p><p>- L&#233;talit&#233; fœtale: The 164 newborns were stillborns is 87.23%.</p></sec><sec id="s3_3"><title>3.3. Etiologies</title><p>The etiologies: The etiologies of uterine rupture were dominated by fetal-pelvic disproportions 48.93% followed by an iatrogenic uterine rupture 22.33%.</p></sec></sec><sec id="s4"><title>4. Discussion</title><p>Frequency: We recorded 24.030 childbirths of which 188 cases of uterine rupture either a frequency of 0.78. What represents an uterine rupture for 128 childbirths. This result is superimposable to the one gotten by SEPOU A. and COLL. is a frequency of 0.6% in 1997 in Centrafrique [<xref ref-type="bibr" rid="scirp.92032-ref11">11</xref>] . On the other hand, it is lower than that obtained by Dolo A. and collaborators in Mali in 1998 and Diallo F.B. and collaborators in Guinea in 1999 which reported respectively 0.89% and 0.98% [<xref ref-type="bibr" rid="scirp.92032-ref8">8</xref>] [<xref ref-type="bibr" rid="scirp.92032-ref10">10</xref>] . The frequency of the uterine rupture would explain itself by the multiplicity of the houses of childbirth holdings by nonqualified beneficiaries, using some ocytociques without indication and practicing of the uterine expressions inopportune having for corollary the uterine rupture.</p><sec id="s4_1"><title>4.1. Epidemiology</title><p>- Age: The age group of 24 to 28 years is the more concerned 31.91%. The middle age was of 28 years with extremes of 14 and 42 years. GUEYE S.M.K and COLL. returned a middle age of 30 years with extremes of 17 to 45 years in 1996 to Senegal [<xref ref-type="bibr" rid="scirp.92032-ref12">12</xref>] .</p><p>- Profession: The housewives were the more concerned with 69.14%. This result is lower to the one returned by GUEYE S.M.K and COLL. is 90% [<xref ref-type="bibr" rid="scirp.92032-ref12">12</xref>] . The predominance of the housewives in our set would explain itself by the fact that they are the most numerous in the feminine population.</p><p>- Prenatal follow-up: The patients without prenatal follow-up represented 47.87%. This frequency would be due to the poverty of the population, the insufficiency of information on the importance of the CPN, the refusal or the carelessness of the gestantes to present itself/themselves regularly to the CPN, the insufficiency or the absence of a personal comp&#233;tant for the realization of CPN of quality in the peripheral centers and the remoteness of the health structures.</p><p>- Parity: The big multiparous with 37.76% were more touched. The middle parity was of 8.95.</p><p>This result is superimposable in the one of GUEYE S.M.K and COLL. to Senegal that returns 40% of uterine rupture at the multiparous with a middle parity of 5 in 1996 [<xref ref-type="bibr" rid="scirp.92032-ref12">12</xref>] .</p></sec><sec id="s4_2"><title>4.2. Clinic</title><p>- Fashion of admission: The evacuees constituted 78.78% of the received patients. This result agrees with the one of LANKOANDE J. and COLL. who returns 78.2% of evacuees in 1995 to Burkina [<xref ref-type="bibr" rid="scirp.92032-ref6">6</xref>] . It could explain itself by the fact that most evacuees stayed a long time little in houses of childbirth holdings by a staff or non qualified, underestimating the dystocies of the childbirth work and managing some ocytociques to these parturientes and don’t decide their evacuations that when they exhausted all tentatives to them carried, that drag the uterine rupture often.</p><p>- Circumstance of discovery: The hemorrhages constituted the main circumstance of discovery in case of cicatricial uterus either 95.74% against 88% on non cicatricial uterus. This result is close to the one of KHABOUZ S. and COLL. 78% found in Morocco in 1999 [<xref ref-type="bibr" rid="scirp.92032-ref13">13</xref>] .</p><p>- Aspect of the uterus: The features of rupture were Transverse in 63.82% of the cases. The features of rupture were transverse in 63.82%, longitudinal in 25.53% and extended to the organs of neighborhood in 10.63% of the cases. In the literature the authors return that the journey of the uterine rupture is in general transverse, almost always toward the left side, because of the dextrotorsion of the uterus [<xref ref-type="bibr" rid="scirp.92032-ref4">4</xref>] .</p><p>- Surgical gestures: The hyst&#233;rorraphie was the surgical gesture the more practiced either 85.10% follow-up of the hysterectomy total sub in 10.63%. This result of the hyst&#233;rorraphie is similar to those found by DIALLO F.B and COLL. in Guinea and KHABOUZ S. and COLL. to Morocco with respectively 81.2% and 80%.</p><p>These gestures are function of some parameters as age, the parity, the number of living child but also the severity of the lesions [<xref ref-type="bibr" rid="scirp.92032-ref14">14</xref>] .</p><p>Weight of birth: The newborns of birth weight superior or equal to 4000 g represent 25.53%. This result is lower to the one found by GUEYE S.M.K and COLL. in Senegal [<xref ref-type="bibr" rid="scirp.92032-ref12">12</xref>] soit 64%. It is evident from our survey that the macrosomie is a factor of non negligible risk of uterine rupture, inciting to the prudence in the decision making of the way of childbirth of these macrosomes.</p><p>- Maternal morbidity: The maternal morbidity has been dominated by the anemia of the postpartum (60%) follow-up of the infection post operative 16.7%. This result is lower to those found by GUEYE S.M.K and COLL. et KHABOUZ S. and COLL. with respectively 2.27% of case of anemia and 11.64% of septicemia [<xref ref-type="bibr" rid="scirp.92032-ref12">12</xref>] [<xref ref-type="bibr" rid="scirp.92032-ref13">13</xref>] .</p><p>This rate raised of anemia in our set would explain itself by the chronic anemia at the pregnant women and the genital hemorrhage at the women having accused a delay of evacuation and a delay of hold in charge. However the infection post-operative would be bound to the organism weakened by anemia, the uterine rupture, to the prolonged work, the conditions of realization of intervention and to a non adapted antibioth&#233;rapie.</p><p>- Maternal L&#233;talit&#233;: We recorded a rate of maternal l&#233;talit&#233; of 12.76%. This rate is intermediate between the one found by DIALLO F.B and COLL. in Guinea and ABASSI H. and COLL. in Morocco with respectively 13.88% and 2.4% [<xref ref-type="bibr" rid="scirp.92032-ref10">10</xref>] [<xref ref-type="bibr" rid="scirp.92032-ref15">15</xref>] .</p><p>- Reasons of maternal death: The maternal deaths were had to in the majority to the hemorrhage 78.57% consistent of the infection postoperative 21.42%. In the literature African; the l&#233;talit&#233; varies from 10% to 35% [<xref ref-type="bibr" rid="scirp.92032-ref6">6</xref>] [<xref ref-type="bibr" rid="scirp.92032-ref8">8</xref>] [<xref ref-type="bibr" rid="scirp.92032-ref12">12</xref>] .</p><p>- Morbidity fœtale: In our set, 18 newborns who endured a respiratory distress are 9.57% of the cases among which 6 survived after a resuscitation. It is largely to the prolonged childbirth work at the evacuated women, the uterine rupture and to the delay in the hold in charge.</p><p>- L&#233;talit&#233; fœtale: The 164 other newborns were stillborns is 87.23%. This result is similar to those found by DIALLO F.B. and COLL. in Guinea and DOLO A. and COLL. in Mali with respectively 83.3% and 90.2% [<xref ref-type="bibr" rid="scirp.92032-ref8">8</xref>] [<xref ref-type="bibr" rid="scirp.92032-ref10">10</xref>] . On the other hand, he/it is lower to the one returned by HELLEN R. and COLL. in USA is 6.57% of death fœtaux [<xref ref-type="bibr" rid="scirp.92032-ref16">16</xref>] . In the literature, the mortality fœtale varies from 72% to 100% [<xref ref-type="bibr" rid="scirp.92032-ref1">1</xref>] [<xref ref-type="bibr" rid="scirp.92032-ref17">17</xref>] . The prognosis fœtal of the uterine rupture is very dark. This report agrees to those of the African literature in which the heavy tribute paid by the fœtus stays a constant [<xref ref-type="bibr" rid="scirp.92032-ref7">7</xref>] .</p><p>- The etiologies: The etiologies of the uterine ruptures were dominated by the foeto-pelvic disproportions 48.93% consistent of the ruptures uterine iatrog&#232;nes 22.33%. This result is superior to those returned by DIALLO F.B. and COLL. in Guinea and DUVERGER V. and COLL. with respectively 16.67% and 7.69% of foeto-pelvic disproportion [<xref ref-type="bibr" rid="scirp.92032-ref10">10</xref>] [<xref ref-type="bibr" rid="scirp.92032-ref18">18</xref>] . It is necessary to note that the uterine rupture provoked by the foeto-pelvic disproportion on healthy uterus is more frequent than the one intervening on a cicatricial uterus. It is due to the fact that a lot of precautions are taken in the childbirths on cicatricial uterus.</p></sec></sec><sec id="s5"><title>5. Conclusion</title><p>The reduction of this uterine rupture rate would pass by the recentered prenatal consultation offer, the one of obstetric cares and complete n&#233;onataux of emergency, the discount to level of the beneficiaries of the basic structures so that they can discover the cases in time susceptible to drag a rupture to evacuate better in time and the promptness in the hold in charge since the admission of the emergencies in the structures of superior level.</p></sec><sec id="s6"><title>Conflicts of Interest</title><p>The authors declare no conflicts of interest regarding the publication of this paper.</p></sec><sec id="s7"><title>Cite this paper</title><p>Diallo, B.S., Balde, I.S., Conte, I., Diallo, M.H., Balde, O., Sylla, I., Diallo, A., Bah, O.H., Avit, L., Sy, T. and Keita, N. (2019) Uterine Rupture: Epidemiological Aspects, Etiologies and Maternal-Fetal Prognosis in the Obstetric Gynecology Department of the Donka CHU Conakry National Hospital, Guinea. Open Journal of Obstetrics and Gynecology, 9, 521-528. https://doi.org/10.4236/ojog.2019.94051</p></sec></body><back><ref-list><title>References</title><ref id="scirp.92032-ref1"><label>1</label><mixed-citation publication-type="other" xlink:type="simple">Aboulfalah, A., Abassi, H.S., Morsad, F., Matar, N. and El Mansouri, A. (2000) Uterine Ruptures during the Test of Work on Cicatricial Uterus: Maternal and Perinatal Consequences. Journal de Gynécologie Obstétrique et Biologie de la Reproduction, 7, 187-190.</mixed-citation></ref><ref id="scirp.92032-ref2"><label>2</label><mixed-citation publication-type="other" xlink:type="simple">Bretones, S., Cousin, C., Gualandi, M.R. and Meiller, G. (1997) Uterine Rupture, about a Case of Spontaneous Rupture to 30 HIS/HER/ITS at a Primipare. 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