DETERMINANTS OF UTERINE RUPTURE IN LABORING MOTHER FROM PASTORALIST COMMUNITIES: UNMATCHEDCASE-CONTROL STUDY AT JINKA AND GAZER HOSPITALS, SOUTHERN ETHIOPIA, 2024

Abstract

Introduction: Uterine rupture represents a critical public health issue, particularly in low- and middle-income countries such as Ethiopia, where access to adequate maternal healthcare is often limited. This obstetric emergency poses significant risks, leading to considerable morbidity and mortality for both mothers and their newborns. Although uterine rupture is relatively rare within the Ethiopian context, the limited evidence and understanding of the contributing factors during labor are concerning, particularly in pastoralist and semi-pastoralist communities. Therefore, this study aimed to identify the determinants of uterine rupture among pastoralist women who gave birth at Gazer and Jinka Hospitals in Southern Ethiopia. Methods: An institution-based unmatched case-control study was conducted involving 405 pastoralist women who gave birth between January 1, 2018, and November 1, 2024, at Jinka and Gazer Hospitals. Among these participants, 144 women experienced uterine rupture and were classified as cases, while 288 women without uterine rupture served as controls. Data were collected using a data extraction checklist through the Open Data Kit application, drawing information from logbooks and client cards. The collected data were subsequently exported to SPSS version 25.0 for comprehensive analysis. To identify factors associated with uterine rupture, binary logistic regression was employed. The adjusted odds ratios, accompanied by a 95% confidence interval, were computed to interpret the results effectively. A p-value of less than 0.05 was deemed statistically significant for the purposes of this study. Results: The odds of experiencing a uterine rupture were found to be 2.9 times higher among women with a gravidity of five or more (AOR = 2.9; 95% CI: 1.20, 6.91) compared to those with a gravidity of four or less. Other independent determinants included referral from other health facilities, a history of cesarean section scar, and fetal macrosomia. Conclusion: This study identified significant associations between gravidity, referrals from other health facilities, previous cesarean sections, and birth weight with the risk of uterine rupture. The findings highlight the need to improve accessibility to emergency obstetric care and enhance referral systems, particularly for laboring mothers with prior cesarean deliveries. Targeted attention to these high-risk individuals can enhance maternal safety and minimize uterine rupture incidents during child birth.