ORIGINAL ARTICLE Anaesthesia for uterine rupture in a Nigerian teaching hospital: maternal and fetal outcome U. V. Okafor, U. Aniebue Departments of Anaesthesia, and Obstetrics and Gynaecology, University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria Background: An observational retrospective study was conducted at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria to determine the outcome for patients with rupture of the gravid uterus who had anaesthesia for laparotomy over a four-year period, July 2000 to June 2004. Methods: The hospital records (case files, labour ward and theatre records) of patients over a four-year period with rupture of the uterus were reviewed. Results: A total of 2707 deliveries took place at UNTH, Enugu, Nigeria. There were 2556 live births (94.8% of deliveries) and 714 (26.4%) caesarean deliveries. Twenty-three cases of uterine rupture occurred, giving a prevalence of 8.5/1000 deliveries. In nine patents (39.1%) the uterus was already scarred. The patientsÕ mean age was 30.2 years. No nulliparous patients suffered ruptured uterus. General anaesthesia with muscle relaxants was administered to all patients. Twenty-two patients (95.6%) received blood transfusions. All the patients received normal saline and one patient also received Haemacel Ò . Five (21.7%) patients had preoperative hypotension and two (8.6%) had intraoper- ative hypotension. There was one maternal death which occurred three days after the cesarean section. Twenty-three (96.3%) fetal deaths, including the loss of a set of twins, were recorded. Fetal deaths from ruptured uterus represented 32.4% of all fetal loss following caesarean section during the study period. There were no neonatal deaths. Conclusion: Rupture of the gravid uterus presents the anaesthetist with the unique challenge of maintaining haemody- namic status before haemostasis is secured, often with the patient in shock. Choice of anaesthetic drugs and availability of blood are important, as well as the skill and experience of the anaesthetist. The maternal mortality rates in other West African studies reviewed were generally higher than those in this series. The maternal outcome re-emphasises the vital role of prompt intervention and availability of blood in reducing maternal mortality following rupture of the uterus. Ó 2005 Published by Elsevier Ltd. Keywords: Anaesthesia; Uterine rupture; Maternal and fetal outcome INTRODUCTION Uterine rupture is an obstetric emergency that poses a serious threat to the life of both mother and fetus. Be- cause the gravid uterus receives 12% of the cardiac out- put, when uterine rupture occurs, haemorrhage can be extremely rapid. 1 Classically, uterine rupture is said to be painful, but asymptomatic rupture occurs in a signif- icant number of patients. 2,3 In addition to haemorrhage, uterine rupture may result in urologic injury, maternal death and perinatal complications including neurologic impairment and death. 4,5 With the urgent need to control haemorrhage, anaes- thesia may have to be induced in patients who are hypovo- laemic and hypotensive, and ultimately a hysterectomy may be needed to save the motherÕs life. 4 A review of the literature revealed a paucity of studies on anaesthetic challenges in the management of ruptured uterus in West Africa, a term used to designate a geographic region within the continent of Africa comprising 19 countries. This study examines the maternal and fetal outcomes following anaesthesia in patients with ruptured gravid uterus and proffers suggestions on how to reduce inci- dence, morbidity and mortality. International Journal of Obstetric Anesthesia (2006) 15, 124–128 Ó 2005 Published by Elsevier Ltd. doi:10.1016/j.ijoa.2005.10.009 Accepted October 2005 U.V. Okafor, Departments of Anaesthesia, U. Aniebue, Departments of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Correspondence to: Dr. U.V. Okafor, PO Box 1521, Enugu, Nigeria. Tel.: +234 42253532; mobile: +234 8035935862. E-mail: uvkafor@yahoo.com. 124