Predictors of Uterine Rupture After One Previous Cesarean Section: An Unmatched Case–Control Study

Temesgen Tantu Arusi,1,2 Dereje Zewdu Assefa,3 Muluken Gunta Gutulo,4 Teshome Gensa Geta5 1Department of Obstetrics and Gynecology, Wolkite University College of Health Science, Wolkite, Ethiopia; 2Department of Obstetrics and Gynecology, Hawassa University, Hawassa City, Ethiopia; 3Department of Anesthesia, Wolkite University College of Medicine and Health Sciences, Wolkite, Ethiopia; 4Wolaita Zone Health Department, Wolaita Zone Health Bureau, Wolaita Sodo, Ethiopia; 5Department of Public Health, Wolkite University College of Health Science, Wolkite, EthiopiaCorrespondence: Temesgen Tantu Arusi, Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, Wolkite University, Wolkite City, Southern Nations State, 2783, Ethiopia, Tel +251913323961, Email tematantu405@gmail.comBackground: Uterine rupture is a rare occurrence but has catastrophic complications during pregnancy. The incidence is relatively higher in scarred uteri because there is a promotion of labor after cesarean section. There is a scarcity of evidence from low-income countries regarding the predictors of uterine rupture after trial labor.Objective: To assess factors determining uterine rupture during labor after the previous cesarean section among mothers delivered at Hawassa University Comprehensive Specialized Hospital from September 2017 to September 2022.Methods: A facility-based unmatched case–control study was done by reviewing 105 patients, which included 35 cases and 70 controls in a 1:2 case-to-control ratio. The association between dependent and independent variables was sought with running binary and multivariate analyses by using the cut point of a p value < 0.05 and 95% CI.Results: The prevalence of uterine rupture is 1.6%. The factors significantly associated with uterine rupture after trial of labor are fetal weight > 3.8 kg (AOR: 5.21), antenatal care 4 (AOR: 3.6), labor duration > 15 hours (AOR: 10.7), and previous successful vaginal delivery (AOR: 3.4). Poor fetal-maternal outcomes like 91.4% fetal death, 29 hysterectomies, 22 blood transfusions, and 1 death.Conclusion: The prevalence is relatively higher than in developed countries. The number of antenatal care, labor duration, and lower fetal weight are not common findings associated with uterine rupture after trial of labor across the literature, so large-scale studies are needed to develop guidelines for the Ethiopian setup. Improving the quality of obstetrics care given in each level of health system.Keywords: TOL, uterine rupture, scar dehiscence, VBAC, Ethiopia