Complete uterine rupture in a tertiary referral hospital in Yemen: incidence and fetomaternal outcomes in a fragile health system

Abstract Background Uterine rupture remains a catastrophic obstetric complication associated with high maternal and perinatal mortality, particularly in low- and middle-income countries with fragile health systems. Evidence from conflict-affected settings such as Yemen is limited. This study aimed to describe the incidence and fetomaternal outcomes of complete uterine rupture in a tertiary referral hospital in Sana’a, Yemen. Methods A descriptive observational hospital-based study was conducted in Al-Sabeen Maternity and Child Hospital between January 2017 and December 2018. All women with complete uterine rupture during the study period were included. Data were extracted from routinely recorded clinical records. Sociodemographic characteristics, obstetric history, antenatal care attendance, place of labor onset, uterine status and maternal and perinatal outcomes were analyzed descriptively. Results During the study period, 39 women with complete uterine rupture were identified among 16,813 births, yielding an incidence of 0.23%. Women were aged 20–30 years in 22/39 cases (56.4%), grand multiparous in 26/39 (66.7%), illiterate in 27/39 (69.2%), and of poor socioeconomic status in 32/39 (82.1%). Most women (30/39; 76.9%) had attended one or no antenatal care visits. Uterine rupture occurred in unscarred uteri in 24/39 cases (61.5%) and in scarred uteri in 15/39 (38.5%), often following prolonged obstructed labor after attempted home or peripheral facility birth. Of the 39 neonates, 34 (87.2%) were stillborn while 5 (12.8%) were born alive; maternal mortality occurred in 2/39 women (5.1%). Conclusion During the study period, complete uterine rupture was a devastating but largely preventable obstetric emergency among women treated at this hospital, associated with extremely high rates of stillbirth and substantial maternal mortality. Poor antenatal care utilization, delayed referral, home birth and obstructed labor were commonly observed among affected women. Strengthening antenatal care coverage, skilled birth attendance, timely referral and comprehensive emergency obstetric care is essential to reduce preventable maternal and fetal deaths in fragile health systems.